Prevention and treatment of renal allograft rejection

New therapeutic approaches and new insights into established therapies

Christopher Y. Lu, Stanley Carlos Sicher, Miguel A. Vazquez

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Renal transplantation is the preferred treatment modality for patients with ESRD who are good surgical risks and able to comply with chronic immunosuppressive medications. Clinical transplantation has advanced significantly, with most transplant centers reporting 1-yr renal allograft survival rates of better than 80%. Nevertheless, rejection and a progressive loss of allografts over time continue to occur. The immunosuppressive agents currently used may lead to the development of life-threatening infections, malignancies, and advanced atherosclerosis as a consequence of some of their side effects. This review examines the mechanisms involved in allograft rejection as currently understood. The recent knowledge into the mechanism of action of cyclosporine, FK506, and rapamycin on T cell activation is presented. Information recently available on some of the established therapies such as steroids, antimetabolites and monoclonal antibodies as well as the newer agents is also discussed. The interaction between clinical transplantation and basic research in immunology continues to result in exciting advances in both fields.

Original languageEnglish (US)
Pages (from-to)1239-1256
Number of pages18
JournalJournal of the American Society of Nephrology
Volume4
Issue number6
StatePublished - Dec 1993

Fingerprint

Allografts
Immunosuppressive Agents
Kidney
Transplantation
Antimetabolites
Tacrolimus
Sirolimus
Allergy and Immunology
Kidney Transplantation
Cyclosporine
Chronic Kidney Failure
Atherosclerosis
Therapeutics
Survival Rate
Steroids
Monoclonal Antibodies
T-Lymphocytes
Transplants
Infection
Research

Keywords

  • Allograft
  • Immunosuppression
  • Kidney
  • Rejection
  • Transplantation

ASJC Scopus subject areas

  • Nephrology

Cite this

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AB - Renal transplantation is the preferred treatment modality for patients with ESRD who are good surgical risks and able to comply with chronic immunosuppressive medications. Clinical transplantation has advanced significantly, with most transplant centers reporting 1-yr renal allograft survival rates of better than 80%. Nevertheless, rejection and a progressive loss of allografts over time continue to occur. The immunosuppressive agents currently used may lead to the development of life-threatening infections, malignancies, and advanced atherosclerosis as a consequence of some of their side effects. This review examines the mechanisms involved in allograft rejection as currently understood. The recent knowledge into the mechanism of action of cyclosporine, FK506, and rapamycin on T cell activation is presented. Information recently available on some of the established therapies such as steroids, antimetabolites and monoclonal antibodies as well as the newer agents is also discussed. The interaction between clinical transplantation and basic research in immunology continues to result in exciting advances in both fields.

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