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Immunosuppressive Agents

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Book cover Transplant Infections

Abstract

Immunosuppression is delivered in three phases: induction, maintenance, and rescue therapy. Induction agents, or intense immunosuppression given at the time of transplant to prevent acute rejection, include polyclonal antibodies (e.g., antithymocyte globulins) or monoclonal antibodies (e.g., basiliximab and alemtuzumab). Maintenance regimens include calcineurin inhibitors (e.g., cyclosporine and tacrolimus), mammalian target of rapamycin inhibitors (e.g., sirolimus and everolimus), antiproliferative agents (e.g., azathioprine and mycophenolic acid), co-stimulatory blockers (e.g., belatacept), and corticosteroids. Rescue agents, or medications used to treat rejection, include corticosteroids, antithymocyte globulins, and alemtuzumab. When selecting immunosuppressive regimens, several factors are considered including immunological risk of rejection, potential for excessive immunosuppression (e.g., infection and cancer), medication side effects, adherence, and cost of medications. In the current era of transplantation, immunosuppression is individualized based on patient characteristics and presence of comorbid disease states. This chapter will describe current approaches to immunosuppression in solid organ transplantation.

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Authors and Affiliations

  1. School of Pharmacy, University of Missouri–Kansas City, 2464 Charlotte St., Rm 2241, Kansas City, MO, 64108, USA

    Karen L. Hardinger Pharm.D.

  2. Transplant Center Dallas Renal Group, Methodist Dallas Medical Center, 3571 W. Wheatland Rd., Suite 101, Dallas, TX, 75237, USA

    Irfan A. Agha M.B.B.S., M.R.C.P. (UK)

  3. Renal Division, Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, Campus Box 8126, St. Louis, MO, 63110, USA

    Daniel C. Brennan M.D.

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  1. Karen L. Hardinger Pharm.D.
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  1. Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Per Ljungman

  2. Tufts University School of Medicine Tufts Medical Center, Boston, MA, USA

    David Snydman

  3. University of Washington Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Michael Boeckh

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Hardinger, K.L., Agha, I.A., Brennan, D.C. (2016). Immunosuppressive Agents. In: Ljungman, P., Snydman, D., Boeckh, M. (eds) Transplant Infections. Springer, Cham. https://doi.org/10.1007/978-3-319-28797-3_3

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