Induction immunosuppressive therapies in renal transplantation

Abstract

No standard induction immunosuppressive regimen exists for patients undergoing renal transplantation. Antithymocyte globulin (rabbit) is the most commonly used agent, whereas basiliximab appears safer. The choice of regimen depends on the preferences of clinicians and institutions.

Induction Therapy in Renal Transplant Recipients

“…Basiliximab inhibition of IL-2 binding occurs through steric hindrance (Fig.7). In this case, the effect is not depletional, but rather, preventative of early T cell activation (Gabardi et al, 2011). …”

“…As an off-label induction agent, it's been used with various immunosuppression regimens, including steroid-sparing regimens. Effectively, it depletes lymphocytes at the time of transplantation and last for several months to a year before the immune system is reconstituted (Gabardi et al, 2011). Alemtuzumab is given at a dose of 30 mg or 0.3 mg/kg through a peripheral line over 3 hours.…”

“…Cytokine release syndrome does not occur, as T cells are not activated or stimulated. The most serious adverse event is hypersensitivity, which is rare (<1%) (Gabardi et al, 2011). There is no increased risk of infectious complications or PTLD compared to no induction therapy (Cherikh et al, 2003).…”

“…Given the favorable side effect profile, it is tolerated well in recipients, irrespective of co-morbid conditions. The main disadvantage of daclizumab, as compared to basiliximab, is that it is more costly and requires repeated administrations (Gabardi et al, 2011). Because the demand for the medication has been relatively low, it has been discontinued by the manufacturer.…”

Tailor-Made Induction Therapy in ‘Low Risk’ Renal Transplants; A South Asian Perspective

“…This is especially useful in deceased donor RT with delayed graft function, where CNI therapy can be delayed until some recovery of the graft is obtained [18,19]. While the overall benefi ts of induction therapy are well documented, they also have inherent adverse reactions including infection and malignancy secondary to the potent inhibition of host immune responses [20,21]. Hence, clear identifi cation of induction agent to be used in each individual patient need to be defi ned using a careful risk-benefi t assessment.…”