Immunosuppressive Drugs And Ocular Complications After Kidney Transplantation
Kidney transplantation is the treatment of
choice for patients with end-stage renal disease and has substantially improved
long-term survival and quality of life. The success of transplantation,
however, relies on lifelong immunosuppressive therapy, which is associated with
a wide range of systemic adverse effects, including potentially
vision-threatening ocular complications. As the life expectancy of transplant
recipients continues to increase, recognition and prevention of drug-related
ocular morbidity have become increasingly important components of comprehensive
post-transplant care. Ocular complications in kidney transplant
recipients arise through multiple mechanisms, including direct pharmacologic
toxicity, microvascular dysregulation, neurotoxicity, impaired tissue repair,
and increased susceptibility to opportunistic infections. This chapter provides
a comprehensive and clinically oriented overview of ocular complications
associated with the major classes of immunosuppressive agents used in renal
transplantation, including corticosteroids, calcineurin inhibitors, mammalian
target of rapamycin (mTOR) inhibitors, and antimetabolites. Corticosteroids
remain the most common cause of ocular morbidity, frequently leading to
posterior subcapsular cataract, steroid-induced glaucoma, and central serous
chorioretinopathy. Calcineurin inhibitors, particularly tacrolimus and
cyclosporine, may produce neuro-ophthalmic complications such as toxic optic
neuropathy and posterior reversible encephalopathy syndrome. In contrast, mTOR
inhibitors primarily affect ocular surface integrity and wound healing, whereas
antimetabolites contribute mainly to ocular pathology through indirect
mechanisms related to immunosuppression and opportunistic infections. Early recognition of immunosuppressive
drug–related ocular complications is critical for preventing irreversible
visual impairment while maintaining adequate graft protection. Close
collaboration between ophthalmologists, nephrologists, and transplant specialists
remains essential to achieve the optimal balance between vision preservation
and long-term graft survival.
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