RENAL-TRANSPLANTATION

Renal transplantation is the treatment of choice for end-stage renal d isease. Recipients of kidney transplants need to be maintained on chro nic maintenance immunosuppression with potentially toxic medications t o prevent rejection, including steroids, azathioprine, and cyclosporin e. Rejection, however, continues to be the most common cause of graft dysfunction, although cyclosporine toxicity may be difficult to differ entiate unless a transplant biopsy is performed. Infections, especiall y with immunomodulating viruses, and posttransplant malignancies are a mong the most serious posttransplant complications that appear to be r elated to the level of overall immunosuppression. Several new immunosu ppressive drugs are currently being tested in clinical trials with the goal of achieving optimal immunosuppression to prevent graft rejectio n and improve graft survival, while minimizing serious toxicity.