Immunosuppressive Drugs Used In Kidney Transplantation
Kidney
transplantation is the most effective treatment for end-stage kidney disease
(ESKD). However, the success of the transplant depends on the prevention of
both early and late-stage rejection. Therefore, immunosuppressive therapy used
to prevent rejection is critical for transplant outcomes. The primary goal of
immunosuppression is to maximize the preservation of graft function while
minimizing the risk of serious side effects, such as infection and drug-induced
toxicity. Immunosuppressive
therapy consists of two stages: intensive "induction" therapy
administered at the time of transplant, followed by lifelong
"maintenance" therapy. The goal of induction therapy is to prevent
the risk of acute rejection, which is highest during the early postoperative
period. Agents used for induction include lymphocyte-depleting agents (e.g., anti-thymocyte
globulin (ATG), alemtuzumab) and non-depleting agents (e.g., basiliximab). The
patient’s immunological risk profile is essential in selecting the induction
agent. For high-risk patients, more potent agents are preferred, whereas for
low-risk patients, agents with a lower potential for side effects are chosen. Following
induction therapy, maintenance therapy is initiated to ensure long-term graft
survival. During this period, a combination therapy consisting of calcineurin
inhibitors (CNIs) (tacrolimus and cyclosporine), which inhibit critical
pathways in T-cell activation; antiproliferative agents (mycophenolate mofetil
(MMF) and Azathioprine
(AZA)); and steroids are used. Both induction and
maintenance immunosuppressive regimens are personalized by considering
individual factors such as the patient’s immunological risk profile, Human
Leukocyte Antigen (HLA) matching, panel reactive antibody (PRA) levels, the
presence of donor-specific antibodies (DSA), and infection history. Effective and safe
immunosuppressive management is achieved through "Therapeutic Drug
Monitoring" (TDM). Regular monitoring of blood levels, especially for
drugs with a narrow therapeutic index like CNIs, prevents both drug toxicity
and the development of rejection due to subtherapeutic levels.
Bu kitabın bölümleri bulunmamaktadır.
Atıf Sayısı :
