The next generation of medications for kidney transplant patients

Transplant pharmacotherapy evolves as new agents are investigated and approved for use. Clinical immunosuppression has been plagued with maintaining a balance between rejection of the transplanted organ and complications of over-immunosuppression, including infection and malignancy. Clinicians must understand current immunosuppressive regimens and their associated effects when caring for transplant patients. While all transplant patients receive some form of immunosuppressive therapy, the combinations and choices increase as new drugs are developed. In the critical and acute care settings, newly transplanted patients will likely receive induction therapy. The goal of induction therapy is to increase long-term patient and allograft survival while preventing or reducing rejection episodes. Several agents are available for induction therapy, and each transplant center designs its own protocol. The foundation for maintenance therapy rests on the combining immunosuppressives to prevent rejection through a variety of pathways. An understanding of the mechanism of action and additive effects of a drug allows practitioners to optimize therapy while decreasing adverse effects. Immunosuppressive therapy offers potential for reducing detrimental patient outcomes and improving allograft survival. It is well established that repeated rejection episodes correlate with poor long-term graft survival. Challenges facing researchers and clinicians focus on improved patient outcomes and options to address financial constraints of transplantation.