Guidelines For Clinical Practice
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World J Transplant. Aug 24, 2012; 2(4): 51-68
Published online Aug 24, 2012. doi: 10.5500/wjt.v2.i4.51
Current state of renal transplant immunosuppression: Present and future
Hari Varun Kalluri, Karen L Hardinger
Hari Varun Kalluri, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15260, United States
Karen L Hardinger, Department of Pharmacy Practice and Administration, University of Missouri-Kansas City, Kansas, MO 64108, United States
Author contributions: All authors have made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content; and final approval of the version to be published.
Correspondence to: Karen L Hardinger, PharmD, BCPS, Clinical Associate Professor of Pharmacy Practice, Department of Pharmacy Practice and Administration, University of Missouri-Kansas City, 2464 Charlotte Street, Rm 2241 Kansas City, MO 64108, United States.
Telephone: +1-816-2769023 Fax: +1-816-2764751
Received: July 27, 2011
Revised: November 23, 2011
Accepted: June 30, 2012
Published online: August 24, 2012

For kidney transplant recipients, immunosuppression commonly consists of combination treatment with a calcineurin inhibitor, an antiproliferative agent and a corticosteroid. Many medical centers use a sequential immunosuppression regimen where an induction agent, either an anti-thymocyte globulin or interleukin-2 receptor antibody, is given at the time of transplantation to prevent early acute rejection which is then followed by a triple immunosuppressive maintenance regimen. Very low rejection rates have been achieved at many transplant centers using combinations of these agents in a variety of protocols. Yet, a large number of recipients suffer chronic allograft injury and adverse events associated with drug therapy. Regimens designed to limit or eliminate calcineurin inhibitors and/or corticosteroid use are actively being pursued. An ideal immunosuppressive regimen limits toxicity and prolongs the functional life of the graft. This article contains a critical analysis of clinical data on currently available immunosuppressive strategies and an overview of therapeutic moieties in development.

Keywords: Review, Immunosuppression, Investigational agents, Renal/ kidney transplant