Immunosuppressive treatment for kidney transplantation

Medicina Fluminensis

Živčić-Ćosić, Stela²  Rački, Sanjin²  Trobonjača, Zlatko¹ 

[1] Zavod za fiziologiju i imunologiju, Medicinski fakultet Sveučilišta u Rijeci;Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar Rijeka

关键词: immunosuppression;    rejection;    renal transplantation;   

DOI  :  

学科分类：医学（综合）

来源: Medicina Fluminensis

【 摘 要 】

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.

【 授权许可】

Unknown