Pharmacotherapy of kidney transplant rejection: Current therapy and
future aspects
Abstract
Renal transplantation is the ultimate therapeutic option for end-stage
renal failure. A major challenge that often leads to the loss of the
renal graft is the immune-mediated organ rejection, of which there are
three types; hyperacute, acute and chronic rejection. This necessitates
a proper use of immunosuppressants in the form of short-term induction
therapy, as prophylaxis against early acute rejection, and a life-long
maintenance therapy against chronic rejection. However, the suppression
of the immune system would also compromise the ability of the immune
system to eradicate the pathogens and early cancer cells, which
increases the risk for various types of serious infections and
malignancies. Some of these drugs are also associated with hematologic,
metabolic, cardiovascular and renal toxicities. This manuscript
thoroughly reviews the available clinical data on the currently approved
drugs that are used for both the induction and maintenance therapy, with
some focus on their pharmacology. It also discusses the current
guidelines and covers, in some details, the new drug classes that are
still under clinical investigations.