Kidney Transplant: Current Practice and New Potential

Abstract

Because of the use of newer available therapies, 5- and 10-year kidney allograft survival rates have improved. Chronic rejection remains the most common cause of graft failure. Moreover, current immunosuppressive drugs, such as calcineurin inhibitors, azathioprine, Mycophenolate mofetil and prednisone have significant side effects associated with long-term use. While acute allograft rejection can be successfully treated and reversed, there remains no decisive treatment for chronic rejection, and graft tolerance is difficult to achieve in humans. A continued goal is to develop sensitive methods to monitor and predict the host response to the allograft to determine the optimum immunosuppressive regimen and doses required to minimize drug-related toxicities and potentially prevent immunological graft failure and develop new agents with fewer side effects. More work is necessary to understand the basis of immunologic tolerance in humans.