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: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
09 May 2017
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| 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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| 245 | 1 | 3 | |a An update on chemical pharmacotherapy options for the prevention of kidney transplant rejection with a focus on costimulation blockade |c Florian Kälble, Matthias Schaier, Sebastian Schäfer, Caner Süsal, Martin Zeier, Claudia Sommerer, Christian Morath |
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| 520 | |a 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). | ||
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