title: [Immunosuppression and its use in kidney transplantation].
abstract: BACKGROUND
  Current immunosuppressive protocols effectively prevent acute rejection of renal allografts. Extensive drug toxicity and the deleterious effects of long-term immunosuppression are associated with significant morbidity and mortality.
  
  
  OBJECTIVE
  The purpose of this article is to provide an overview over modern immunosuppressants and their unwanted side effects and to discuss strategies for improved long-term transplant survival.
  
  
  METHODS
  Review of the current topic-related literature and discussion of our own experience.
  
  
  RESULTS
  The use of antibody induction together with an initial combination therapy of calcineurin inhibitors, mycophenolate and steroids is recommended and results in excellent early outcomes. Detrimental effects include an increased incidence of infections, malignomas, and cardiovascular diseases. Long-term transplant survival is impaired by extensive drug toxicity and the frequent development of donor specific antibodies. Reduction of overall cumulative exposure to immunosuppressants or the reduction of specific toxic drugs such as calcineurin inhibitors and steroids may improve long-term results. Alternative immunosuppressants like mTOR inhibitors and belatacept appear to be effective and safe but their long-term effects on patient and allograft survival needs to be established in clinical trials.
  
  
  CONCLUSIONS
  Current immunosuppressants provide effective protection from renal allograft rejection. However, their use is complicated by serious side effects. In the future, development of novel immunosuppressants and optimization of minimization strategies may help to improve long-term success after kidney transplantation.
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Paliege
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Bamoulid
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Bachmann
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland.
authors.forename: O
authors.initials: O
authors.lastname: Staeck
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Halleck
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Khadzhynov
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Brakemeier
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Dürr
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland. klemens.budde@charite.de.
authors.forename: K
authors.initials: K
authors.lastname: Budde
mesh_terms: D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000517:prevention & control; D019317:Evidence-Based Medicine; D006084:Graft Rejection / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007154:Immune System Diseases / Q000139:chemically induced* / Q000517:prevention & control; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D009369:Neoplasms / Q000139:chemically induced / Q000517:prevention & control; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: Graft rejection; Immune system; Infectious diseases; Long-term immunosuppression; Transplant survival