Immunosuppression

The primary objective of clinical immunosuppression following renal transplantation is to prevent rejection while limiting the toxicities of the immunosuppressive agents. A balance between over- and underimmunosuppression can be difficult to accomplish and has significant ramifications if not achieved. The major sequelae of underimmunosuppression are cellular and antibody-mediated allograft rejection, whereas overimmunosuppression can give rise to complications such as infection and malignancy. Local protocols and national/international guidelines have been established to aid in the streamlining of immunosuppressive regimens; however, the development of the most appropriate immunosuppressive therapy in an individual transplant recipient is highly dependent on a practitioner’s experience, preexisting medical conditions/medications, and donor characteristics. Despite the success seen by our individualized immunosuppressive regimens in improving short-term outcomes, late graft loss and the morbidity associated with long-term immunosuppression remain major concerns. To improve outcomes in renal transplantation, it is imperative that clinicians be aware of the specific advantages and disadvantages of the available immunosuppressants, as well as the potential for adverse drug reactions and drug-drug interactions commonly seen with these agents. This review contains 5 figures, 5 tables and 92 references Key Words: immunosuppression, pharmacodynamics, pharmacokinetics, renal transplantation