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Immunosuppression: Induction, Maintenance, and Steroid Avoidance Protocols

  • Bruce A. Kaiser
  • Martin S. Polinsky
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)

Abstract

During the past 50 years, kidney transplantation has become an increasingly successful form of renal replacement therapy, as demonstrated, in particular, by the dramatic improvements in 1-year patient and allograft survival rates. These have improved to over 90% for both deceased and living donor allografts, and acute rejection rates have decreased to approximately 10% at 1 year. To a great extent, this improvement correlates with the availability of a greater number of more effective immunosuppressive medications and, for selected drugs, the availability of therapeutic drug monitoring. Currently nearly two-thirds of all recipients receive some form of induction therapy at the time of transplantation and then remain on a maintenance regimen of two or three medications. The combinations of drugs that are currently available can be adjusted to allow the therapy to be individualized between patients to deliver adequate immunosuppression while minimizing side effects and maximizing both patient and graft survival.

Keywords

Kidney transplantation Allograft survival Acute rejection Pediatric Immunosuppressive medications Induction therapy Maintenance therapy Calcineurin inhibitor Interleukin-2 receptor antagonist Antithymocyte globulin Alemtuzumab Azathioprine Mycophenolate mofetil Rapamycin Belatacept 

Abbreviations

APC

Antigen-presenting cell

ATG

Antithymocyte globulin

AZA

Azathioprine

CMV

Cytomegalovirus

CNI

Calcineurin inhibitors

CS

Corticosteroids

CsA

Cyclosporine A

DSA

Donor-specific antibodies

EBV

Epstein-Barr virus

eGFR

Estimated or calculated glomerular filtration rate

EVL

Everolimus

HLA

Major histocompatibility complex antigens

IL-2 RA

Interleukin-2 receptor antagonist

KDIGO

Kidney disease improving global outcome

mGFR

Measured glomerular filtration rate

MMF

Mycophenolate mofetil

mTOR

Mammalian target of rapamycin

mTORi

Mammalian target of rapamycin inhibitor

PRA

Panel reactive antibodies

PTLD

Posttransplant lymphoproliferative disorder

r-ATG

Rabbit ATG (antithymocyte globulin), thymoglobulin

SRL

Sirolimus

TAC

Tacrolimus

TCR

T-cell receptor complex

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Solid Organ Transplantation, EmeritusAlfred I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Global Clinical Research, ImmunologyBristol-Myers Squibb, Pharmaceutical Research InstitiutePrincetonUSA

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