Immunosuppression in high-risk transplantation.
OBJECTIVE
Increasingly, transplant clinicians are faced with providing candidates with increased risks for poorer outcome with donor grafts that also carry higher risks of failure. Understanding the role of immunosuppressive management in these combinations of higher risks remains important for optimizing results.


RESULTS
Few immunosuppressive protocols have been rigorously tested in the high-risk renal transplant setting. The two main risk categories accounted for in the trials are those ones that confer increased risks to renal function, usually carried by the donor organs, and those protocols defined by increased risk for immunological failure, mostly determined by recipient characteristics. The studied protocols generally involve reduction or avoidance of nephrotoxic drugs in the first case and use of lymphocyte-depleting agents in the case of increased immunological risk. In both scenarios, acceptable short-term results have been achieved. However, long-term results for high-risk transplants defined either by donor or recipient factors have yet to be reported.


CONCLUSIONS
The lack of long-term data for optimizing the right immunosuppressive regimen for a given donor/recipient risk profile remains an ongoing challenge for researchers and clinicians alike.
Rhee
Jason
J
Department of Surgery, Tufts Medical Center, Boston, Massachusetts 02111, USA.
Al-Mana
Nora
N
Freeman
Richard
R
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005006:Ethnicity; D006084:Graft Rejection / Q000208:ethnology / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000208:ethnology; D008875:Middle Aged; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents