Recent advances in immunosuppressive therapy for renal transplantation

Recent advances in immunosuppression have focused on more effective, safer, and targeted therapies that have resulted in improved short- and intermedi ate-term renal allograft survival. During the past decade there has been a marked decrease in acute rejection rates following renal transplantation be cause of the use of newer immunosuppressive agents. Recent data indicate th at the average yearly reduction in the relative hazard of graft failure bey ond I year was 4.2% for all recipients (0.4% for those recipients who had a n acute rejection episode and 6.3% for those who did not have an acute reje ction). Despite these improvements the currently available immunosuppressiv e agents are associated with significant cardiovascular risk factors, an in creased risk of infection, and the development of malignancies in the long term. Predictive parameters of donor-specific hyporesponsiveness are needed so as to allow identification of patients in whom immunosuppressive therap y can be safely reduced. Immunosuppressive agents that have recently been a pproved for use in the United Slates and those that are in clinical and pre clinical studies are discussed.