title: Induction Immunosuppression in High-risk Kidney Transplant Recipients.
abstract: Kidney transplant remains the best type of renal replacement therapy in most patients with end-stage kidney disease, even in those with high immunologic risk. Immunosuppression in these patients is regarded as more complex, owing to the higher risk of both acute and chronic rejection. The advent of induction immunosuppression has resulted in a lower incidence of acute rejection and consequently improved short-term patient and allograft outcomes. Indeed, the use of these agents, especially in high-risk recipients, has become standard of care at most transplant centers. Transplant physicians are constantly faced with the challenge of estimating the recipients' immunologic risk and tailoring their immunosuppression accordingly. This review article aims to provide an up-to-date evaluation of the various studies available, which investigated the use of induction agents in kidney transplant, specifically in high-risk recipients. It evaluates the use of the most frequently used polyclonal antibody (rabbit antithymocyte globulin) versus the less commonly used monoclonal antibody alemtuzumab, superseded agents such as muromonab-CD3, and potentially emerging agents such as rituximab, bortezomib, and eculizumab. With this systematic review, we hope to inform the scientific community and facilitate this controversial decision through the implementation of robust scientific evidence.
authors.affiliation: From the Renal Division, Department of Medicine, Mater Dei Hospital, Malta; and the Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, United Kingdom.
authors.forename: Jesmar
authors.initials: J
authors.lastname: Buttigieg
authors.forename: Bridson M
authors.initials: BM
authors.lastname: Julie
authors.forename: Ajay
authors.initials: A
authors.lastname: Sharma
authors.forename: Ahmed
authors.initials: A
authors.lastname: Halawa
mesh_terms: D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006084:Graft Rejection / 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*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents