Immunosuppression for kidney transplantation: Where are we now and where are we going?
Advances in immunosuppression have propelled kidney transplantation from a scientific curiosity to the optimal treatment for patients with end stage kidney disease. Declining rates of acute rejection have led to improvements in short term kidney transplant survival, culminating in incrementally better long term patient and allograft outcomes. Contextualized around established immune-suppressing drug targets, this review summarizes the history of the clinical science and highlights the pivotal trials that have led to present-day treatment standards at the level of both individual agents and multidrug regimens for kidney recipients. Finally, recently approved and emerging therapies are discussed, with an emphasis on challenges faced by clinicians managing this increasingly complex patient population.
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Mary Ann
MA
Lim
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jatinder
J
Kohli
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: rdbloom@mail.med.upenn.edu.
Roy D
RD
Bloom
D064591:Allografts / Q000187:drug effects / Q000276:immunology; D005260:Female; D005544:Forecasting; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000592:standards / Q000639:trends*; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D014181:Transplantation Immunology / Q000187:drug effects*; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents