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An update on chemical pharmacotherapy options for the prevention of kidney transplant rejection with a focus on costimulation blockade

Introduction: The introduction of calcineurin inhibitors (CNI) has greatly improved graft survival in the past three decades. However, long-term graft survival is still limited due to chronic allograft injury and side-effects of immunosuppressive medication. Areas covered: The present overview gives...

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Main Authors: Kälble, Florian (Author) , Schaier, Matthias (Author) , Schäfer, Sebastian Markus (Author) , Süsal, Caner (Author) , Zeier, Martin (Author) , Sommerer, Claudia (Author) , Morath, Christian (Author)
Format: Article (Journal)
Language:English
Published: 09 May 2017
In: Expert opinion on pharmacotherapy
Year: 2017, Volume: 18, Issue: 8, Pages: 799-807
ISSN:1744-7666
DOI:10.1080/14656566.2017.1323876
Online Access:Verlag, Volltext: http://dx.doi.org/10.1080/14656566.2017.1323876
Verlag, Volltext: https://doi.org/10.1080/14656566.2017.1323876
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Author Notes:Florian Kälble, Matthias Schaier, Sebastian Schäfer, Caner Süsal, Martin Zeier, Claudia Sommerer, Christian Morath
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Summary:Introduction: The introduction of calcineurin inhibitors (CNI) has greatly improved graft survival in the past three decades. However, long-term graft survival is still limited due to chronic allograft injury and side-effects of immunosuppressive medication. Areas covered: The present overview gives an update on pharmacotherapeutic strategies after kidney transplantation. The main focus is on CNI-sparing regimens using co-stimulatory blockade and on new substances on the horizone. Expert opinion: CNI sparing regimens are well-established. Complete CNI avoidance after kidney transplantation was often associated with impaired graft survival until the approval of the co-stimulation blocker belatacept for de novo immunosuppression after kidney transplantation. Concerns still exist with respect to severe T-cell-mediated rejection episodes in the early phase after transplantation. Thus, a triple drug regimen with CNI, mycophenolic acid and steroids still represents the gold-standard of immunosuppressive therapy. Alternative substances expand the possibilities of tailoring individual immunosuppression for different indications such as biopsy-proven CNI toxicity, polyoma virus BK nephropathy or CNI-triggered thrombotic microangiopathy. However, a change of the immunosuppressive therapy must always be balanced against each patient´s individual immunological risk in order to address the importance of chronic antibody-mediated rejection driven by donor specific antibodies (DSA).
Item Description:Published online: 09 May 2017
Gesehen am 07.08.2018
Physical Description:Online Resource
ISSN:1744-7666
DOI:10.1080/14656566.2017.1323876

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