Kidney Transplant-Immunosuppression and Rejection

Advances in immunosuppression medications have led to significant improvement in renal transplantation outcomes over the past few decades. The introduction of cyclosporine in the 1980s resulted in a reduction of acute rejection rates and prolonged short-term graft survival. The use of induction immunosuppression agents combined with the development of new maintenance therapies have led to a further decrease in early rejection episodes, making allo-immune causes of early graft loss rare. Despite these advances, overall graft survival remains unchanged in recent years. Therapies for the treatment of rejection have evolved over time. Special populations within the transplant community may warrant tailored immunosuppressive therapy. The transplant team and patient are challenged with deliberating the risks and benefits of these immunosuppression medications. This chapter details current strategies, evidence, and risk profiles of immunosuppressive medications for kidney transplantation along with treatment and prevention of rejection.