Immunosuppression and renal transplant rejection: review of current and emerging therapies

Author(s): Roberto Marcen

Acute rejection associated with chronic rejection and graft loss was a common complication after renal transplantation. Introduction of the new immunosuppressive agents dramatically decreased its incidence, but the negative impact on graft survival persisted. This has been in part attributed to the fact that the new immunosuppressive agents could only control those rejection episodes, without an effect on graft survival. So, differences in acute rejection rates in clinical trials were not followed by improvements in graft survival. Moreover, recent studies suggest that antibody-mediated injury, which is not controlled by the currently used immunosuppressive agents, plays an important role in long-term graft loss. New immunosuppressive agents, such as rituximab and bortezomib, targeting humoral mechanisms of rejection, or belatacept, which preserves graft function, could improve long-term outcomes.