IMMUNOSUPPRESSION IN RENAL-TRANSPLANTATIO N - CURRENT STATUS AND PROSPECTS

Introduction of cyclosporin A has markedly improved the results of ren al transplantation. Currently, nearly all immunosuppression regimens a re cyclosporin-based. To avoid cyclosporin-associated nephrotoxicity a nd to reduce undesirable side effects of other immunosuppressive drugs a variety of treatment strategies has been developed ranging from cyc losporin monotherapy to triple therapy or to later conversion to azath ioprine. FK 506 is a promising new immunosuppressant that has properti es similar to cyclosporin. Its definite value for renal transplanation is under evaluation. A number of new immunosuppressive agents has bee n developed with molecular mechanisms of action that are different fro m cyclosporin A. Rapamycine blocks the transduction of the interleukin 2/IL-2 receptor signal. Antiproliferative drugs such as RS-61443 and brequinar may inhibit lymphocytic DNA synthesis more effectively than does azathioprine. 15-Deoxyspergualin suppresses macrophage function, inhibits lymphocyte clonal expansion and suppresses antibody productio n by B cells. A large array of new monoclonal antibodies has been deve loped, that can be used in prophylaxis and treatment of acute rejectio n. Murine monoclonal antibodies of the IgA class specifically directed at the CD3 molecular complex may have fewer side effects than OKT 3. Other antibodies directed at the T cell receptor, at the IL-2 receptor or at adhesion molecules are being evaluated, but as yet, their futur e impact on the success rate of renal transplanation is uncertain.