title: Optimizing Immunosuppressive Regimens Among Living-Donor Renal Transplant Recipients.
abstract: OBJECTIVE
  We review different immunosuppressant protocols used for living-donor kidney transplant recipients at our center.
  
  
  METHODS
  Many prospective randomized studies from our center have been reported between March 1976 and 2016, with more than 2700 renal transplant procedures conducted. The first study was a prospective randomized trial of azathioprine versus cyclosporine. The second study compared triple therapy (prednisolone + azathioprine + cyclosporine) versus conventional therapy (prednisolone + azathioprine). The third study was a cost-saving study, in which 100 patients received ketoconazole along with the triple regimen. Another trial demonstrated the advantages of a microemulsion form of cyclosporine. A subsequent trial compared calcineurin inhibitor minimization versus avoidance protocols. Rescue therapies were carried out to intensify immunosuppressive regimens after repeated rejection. In addition, steroid-free regimens were evaluated during both short- and long-term treatment. A recent trial reported a step-forward avoidance protocol with a calcineurin inhibitor and a steroid-free regimen, whereas another current study is the TRANSFORM one. The rationale behind antibody therapy was tho roughly evaluated among living-donor renal trans plant recipients with different agents, including basiliximab, daclizumab, antithymocyte globulin, and alemtuzumab.
  
  
  RESULTS
  Earlier studies have demonstrated the efficacy of conventional regimens without induction therapy, especially in longer follow-up. The standard triple therapy has emerged with intensified immunosuppressive and lowered dose of each drug, especially cyclosporine. In minimization studies, no significant differences were encountered regarding patient and graft survival, even in the long-term. Steroid avoidance was safe and effective. Calcineurin inhibitors and steroid-free regimens have shown comparable patient and graft survival. Induction therapy has lowered the incidence and severity of acute rejection.
  
  
  CONCLUSIONS
  A better 5-year graft survival and less posttransplant complications have been achieved with steroid avoidance after induction with basiliximab. Induction therapy did not affect graft and patient survival rates despite lowered incidence and severity of acute rejections.
authors.affiliation: Department of Dialysis and Transplantation, The Urology and Nephrology Center, Mansoura University, Egypt.
authors.forename: Mohamed Adel
authors.initials: MA
authors.lastname: Bakr
authors.forename: Ayman Maher
authors.initials: AM
authors.lastname: Nagib
authors.forename: Osama Ashry
authors.initials: OA
authors.lastname: Gheith
authors.forename: Ahmed Farouk
authors.initials: AF
authors.lastname: Hamdy
authors.forename: Ayman Fathi
authors.initials: AF
authors.lastname: Refaie
authors.forename: Ahmed Farouk
authors.initials: AF
authors.lastname: Donia
authors.forename: Ahmed Hassan
authors.initials: AH
authors.lastname: Neamatalla
authors.forename: Khaled Farouk
authors.initials: KF
authors.lastname: Eldahshan
authors.forename: Ahmed Abdelfattah
authors.initials: AA
authors.lastname: Denewar
authors.forename: Mohamed Hamed
authors.initials: MH
authors.lastname: Abbas
authors.forename: Amany Ismail
authors.initials: AI
authors.lastname: Mostafa
authors.forename: Mohamed Ahmed
authors.initials: MA
authors.lastname: Ghoneim
mesh_terms: D004334:Drug Administration Schedule; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D004534:Egypt; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents