Klin Farmakol Farm. 2010;24(2):98-102 [Prakt. lékáren. 2010; 6(2): 84-86]

Immunosuppression after kidney transplantation

Ondřej Viklický

Klinika nefrologie, Transplantační centrum, Institut klinické a experimentální medicíny, Praha

Successful kidney transplantation depends on the quality of the donor organ, surgical procedure and immunosuppressive regimen. Immediately

before and shortly after transplantation, induction immunosuppression is used, based on T lymphocyte depletion or blockade

of function. In patients at risk of rejection, antithymocyte globulin is used while, in patients at low risk, monoclonal antibody basiliximab

against interleukin-2 receptor is used. Long-term immunosuppression mostly consists of a combination of calcineurin inhibitor (tacrolimus

or cyclosporin A) together with mycophenolate mofetil, an inhibitor of purine synthesis, and steroids. When there is a history of malignancy,

alternative treatment with proliferation signal inhibitors (sirolimus or everolimus) comes into question. When rejection occurs, steroid

pulses are used; if this treatment fails, antithymocyte globulin is used. Long-term immunosuppression is burdened with the occurrence of

a number of adverse effects, including infection, cardiovascular complications, nephrotoxicity and tumours. New promising nonnephrotoxic

immunosuppressants include belatacept, a fusion protein. The other new molecules are currently subject to clinical trials.

Keywords: kidney transplantation, tacrolimus, mycophenolate moeftil, sirolimus, rejection

Published: July 1, 2010  Show citation