Review article
Immunosuppressive treatment for kidney transplantation
Stela Živčić-Ćosić
orcid.org/0000-0002-0770-8808
; Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar Rijeka
Zlatko Trobonjača
; Zavod za fiziologiju i imunologiju, Medicinski fakultet Sveučilišta u Rijeci
Sanjin Rački
; Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar Rijeka
Abstract
The development of new immunosuppressive drugs and knowledge gained through
their usage in different combinations in immunosuppressive protocols, has significantly
improved results after renal transplantation. Immunosuppressive treatment aims at a
reduction of unwanted immune activity, but complications often arise in the form of
infections, metabolic disorders, arterial hypertension, tumors, and other side-effects. In this
paper, we describe the mechanisms of action of available immunosuppressive drugs, their
application for renal transplantation and their side-effects. In the majority of patients, the
immunosuppressive protocol includes a calcineurin inhibitor, tacrolimus or cyclosporin, the
antimetabolite mycophenolate mofetil or mycophenolic acid, and a corticosteroid. Early after
transplantation, acute rejection is suppressed with higher doses of immunosuppressive drugs
or an induction agent, monoclonal or polyclonal antilymphocytic antibodies. These drugs
allow a one-year survival of renal allografts in over 90 % of cases, and an incidence of acute
rejection reactions below 15 %. Acute cell-mediated rejection is treated with pulse doses of
methylprednisolone intravenously, less often with antilymphocytic antibodies. Acute humoral
rejection, characterized through specific pathohystologic changes and donor-specific
antibodies in the recipient’s serum, is treated with high doses of intravenous immunoglobulines
(IVIG) or low doses of cytomegalovirus hyperimmune globuline (CMVIG) together with
plasmapheresis until a satisfactory reduction of anti-donor antibodies is obtained. Rarely,
immunoadsorption, rituximab, alemtuzumab or splenectomy are applied. Investigations of
immunosuppressive agents and their mechanisms of action have lead to the discovery of a
large number of potential drugs. However, their application in the immunosupressive treament
for renal transplantation has to be preceeded by large randomized controlled trials.
Keywords
immunosuppression; rejection; renal transplantation
Hrčak ID:
63064
URI
Publication date:
8.12.2010.
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