Current state of renal transplant immunosuppression: Present and future

Table 1 Food and drug administration approved immunosuppressive medications used for transplantation

Drug	Dose	Side effects
Induction
Basiliximab	20 mg IV × 2 doses	Hypersensitivity reactions
Anti-thymocyte globulin
Rabbit	1.5 mg/kg IV × 3-14 d	Rash, fever, thrombocytopenia, leukopenia
Horse	15 mg/kg IV × 3-14 d
Maintenance
Prednisone	Maintenance: 2.5-10 mg/d	Mood disturbances, psychosis, cataracts, hypertension, fluid retention, peptic ulcers, osteoporosis, muscle weakness, impaired wound healing, glucose intolerance, weight gain
	Rejection: 250-1000 mg/d × 3 d IV
Cyclosporine	4-5 mg/kg po twice daily	Neurotoxicity, gingival hyperplasia, hirsutism, hypertension, hyperlipidemia, glucose intolerance, nephrotoxicity, electrolyte disturbances
Tacrolimus	0.05-0.075 mg/kg po twice daily	Neurotoxicity, alopecia, hypertension, hyperlipidemia, glucose intolerance, nephrotoxicity, electrolyte disturbances
Sirolimus	2-10 mg/d po daily	Hypertriglyceridemia, anemia, thrombocytopenia, mouth sores, hypercholesterolemia, gastrointestinal disturbances, bone marrow suppression, poor wound healing, edema
Everolimus	0.75 mg po twice daily	Hypertriglyceridemia, anemia, thrombocytopenia, mouth sores, hypercholesterolemia, gastrointestinal disturbances, bone marrow suppression, poor wound healing, edema
Azathioprine	1-2.5 mg/kg per day po daily	Leukopenia, thrombocytopenia, gastrointestinal disturbances, pancreatitis, hepatotoxicity
Mycophenolate mofetil	500-1500 mg po twice daily	Leukopenia, thrombocytopenia, gastrointestinal disturbances
Mycophenolate sodium	360-1080 mg po twice daily	Leukopenia, thrombocytopenia, gastrointestinal disturbances
Belatacept	10 mg/kg administered, prior to implantation, on day 5, and at the end of weeks 2, 4, 8, and 12, then 5 mg/kg every 4 wk (plus or minus 3 d)	Post-transplant lymphoproliferative disorder, progressive multifocal leukoencephalopathy