Immunosuppressive drugs in renal transplantation: A review of the regimens

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Currently, expected 10-year first graft survival rates for kidneys from HLA-identical sibling, 1-haplotype-matched relative, and cadaver donors are 74, 51, and 40%, respectively. Histocompatibility, immunological conditioning with blood products, and immunosuppression with glucocorticoids, azathioprine, cyclosporin, and the antithymocyte (antilymphocyte) antibody preparations have been significant factors in the gradual improvement of kidney graft survival rates. Nearly all immunosuppression regimens are cyclosporin-based. Antithymocyte antibody induction therapy with delayed administration of cyclosporin is widely practised to avoid cyclosporin nephrotoxicity while the kidney graft is recovering from preservation injury. Late cyclosporin withdrawal results in inferior cadaver kidney transplant survival rates. Rejection crises usually respond to high dose glucocorticoid therapy. Glucocorticoid-resistant rejection usually responds to treatment with antithymocyte antibody. FK-506 is a promising new immunosuppressant that has properties similar to cyclosporin. Prophylaxis against viral, bacterial and fungal infections is necessary to reduce the morbidity of immunosuppression. The incidence of malignant conditions associated with viral infections is significantly increased with immunosuppression. New immunopharmacological agents and advances in genetic procedures may allow the induction of specific transplantation tolerance and successful xenotransplantation within the next decade.

Original languageEnglish (US)
Pages (from-to)554-566
Number of pages13
JournalDrugs
Volume44
Issue number4
StatePublished - 1992

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Immunosuppressive Agents
Kidney Transplantation
Cyclosporine
Immunosuppression
Grafts
Pharmaceutical Preparations
Glucocorticoids
Kidney
Survival Rate
Graft Survival
Virus Diseases
Cadaver
Transplantation Tolerance
Transplants
Heterologous Transplantation
Histocompatibility
Antilymphocyte Serum
Mycoses
Antibodies
Azathioprine

ASJC Scopus subject areas

  • Toxicology
  • Health, Toxicology and Mutagenesis

Cite this

Immunosuppressive drugs in renal transplantation : A review of the regimens. / Barry, John.

In: Drugs, Vol. 44, No. 4, 1992, p. 554-566.

Research output: Contribution to journalArticle

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