Goal of immunosuppression in kidney transplantation
The central goal of immunosuppression is to prevent rejection of the renal allograft.
The intensity of immunosuppression must be weighed against the undesired consequences of immunodeficiency, such as infection or cancer.
Close monitoring, knowledge, and expertise are required to balance the efficacy and toxicity of kidney transplantation immunosuppression.
1. The intensity of immunosuppression must be weighed against the undesired consequences of immunodeficiency (infection or cancer).
2. Immunosuppression is divided into the induction phase and maintenance phase. Induction involves lymphocyte and non-lymphocyte depleting agents commonly with pulse dose steroids. Maintenance therapy involves CNIs, anti-metabolites, mTOR inhibitors, steroids, and co-stimulation blockade with Belatacept.
3. CNIs remain a cornerstone of immunosuppressive regiments in kidney transplantation. This class of drugs works by blocking calcineurin, an intricate protein in the signal transduction pathway.
4. Deciding on immunosuppression strategy from induction to maintenance should be individualized as per the patient’s individual risk for rejection and metabolic complications.
5. The issue of steroid use post-transplantation remains controversial and requires further investigation to identify the optimal strategy. For now, the use of steroids post-transplantation should be individualized, considering a recipient’s comorbidities and overall risk of allograft rejection.