title: Immune minimization strategies in renal transplantation.
abstract: Very low early rejection rates and excellent short-term kidney allograft outcomes have been the mainstay of forwarding the field of Kidney Transplantation in the last few decades. This progress is mainly achieved by using the current armamentarium of maintenance immunosuppression in different combinations and dosages of calcineurin inhibitors (CNI), corticosteroids and antiproliferative drugs. Metabolic risks and nephrotoxicity of CNIs has led to a search for strategies to minimize their use. Similarly, metabolic risks, mood abnormalities and Cushing-like side effects of steroids have forced physicians and patients alike to try to minimize their use in transplantation. Here, we review the most recent randomized controlled trials of minimization of CNI/steroids in a manner (with incident immunologic risks, state of net immunosuppression and side- effects) that may be helpful to choose the best strategy for the individual patient. New trials testing minimization strategies should include in their design, an assessment of the impact of minimization on development of donor specific antibodies and antibody-mediated rejection as well as long-term outcomes.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin at Madison , Madison, WI , USA and.
authors.forename: Jyoti Eknoor
authors.initials: JE
authors.lastname: Brar
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000378:metabolism; D016030:Kidney Transplantation; D057285:Precision Medicine; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D007518:Isoantibodies
keywords: Calcineurin inhibitors; corticosteroids; minimization; transplantation