Sangeetha Prabhakaran, University of Minnesota, Minneapolis, Minnesota, USA
Abhinav Humar, University of Minnesota, Minneapolis, Minnesota, USA
Arthur J Matas, University of Minnesota, Minneapolis, Minnesota, USA
Published online: May 2008
DOI: 10.1002/9780470015902.a0001242.pub2
Clinical immunosuppression is the reduction of undesirable immunologic activity, usually achieved using immunosuppressive drugs. It is used in a variety of medical conditions, including inflammatory diseases and autoimmune disorders, but its most common application is in the field of organ transplantation.
Keywords: posttransplant immunosuppression; side effects; mechanism; immunosuppressive drugs
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Figure 1. Sites of action of new immunosuppressive drugs.
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| Further Reading | |
| Belatacept | |
| Larsen CP, Pearson TC, Adams AB et al. (2005) Rational development of LEA29Y (belatacept), a high-affinity variant of CTLA4-Ig with potent immunosuppressive properties. American Journal of Transplantation 5(3): 443–453. | |
| Vincenti F, Larsen C, Durrbach A et al. (2005) Belatacept Study, Group Costimulation blockade with belatacept in renal transplantation. New England Journal of Medicine 353(8): 770–781. | |
| Cyclosporine | |
| Cole E, Keown P, Landsberg D et al. (1997) Safety and tolerability of cyclosporine and cyclosporine microemulsion during 18 months of follow-up in stable renal transplant recipients: a report of the Canadian Neoral Renal Study Group. Transplantation 65(4): 505–510. | |
| Keown P for the Canadian and International Neoral study group (1996) Use of cyclosporine microemulsion (Neoral), in de novo and stable renal transplantation: clinical impact, pharmacokinetic consequences, and economic benefits. Transplantation Proceedings 28(4): 2147. | |
| Levy GA (1996) Neoral therapy in liver transplantation. Transplantation Proceedings 28(4): 2225. | |
| MMF | |
| Gonzalez Molina M, Seron D, Garcia del Moral R et al. (2004) Mycophenolate mofetil reduces deterioration of renal function in patients with chronic allograft nephropathy. A follow-up study by the Spanish Cooperative Study Group of Chronic Allograft Nephropathy. Transplantation 77(2): 215–220 January 27. | |
| Remuzzi G, Lesti M, Gotti E et al. (2004) Mycophenolate mofetil versus azathioprine for prevention of acute rejection in renal transplantation (MYSS): a randomized trial. Lancet 364(9433): 503–512 August 7. | |
| Weir MR, Blahut S, Drachenburg C et al. (2004) Late calcineurin inhibitor withdrawal as a strategy to prevent graft loss in patients with suboptimal kidney transplant function. American Journal of Nephrology 24(4): 379–386 July–August. Epub January 25. | |
| Monoclonal antibodies | |
| Buhaescu I, Segall L, Goldsmith D et al. (2005) New immunosuppressive therapies in renal transplantation: monoclonal antibodies. Journal of Nephrology 18(5): 529–536 September–October. | |
| Magliocca JF and Knechtle SJ (2006) The evolving role of alemtuzumab (Campath-1H) for immunosuppressive therapy in organ transplantation. Transplant International, 19(9): 705–714(10). | |
| Morris PJ and Russell NK (2006) Alemtuzumab (Campath-1H): a systematic review in organ transplantation. Transplantation 81(10): 1361–1367, May 27. | |
| Nashan B, Moore R, Amlot P, Schmidt AG and Abeywickrama K (1997) randomized trial of basiliximab versus placebo for control of acute cellular rejection in renal allograft recipients. Lancet 350: 1193–1198. | |
| Pescovitz MD (2006) Rituximab, an anti-CD20 monoclonal antibody: history and mechanism of action. American Journal of Transplantation 6(5): 859–866(8). | |
| Vincenti F, Kirkman R, Light S et al. (1998) IL-2 receptor blockade with Daclizumab to prevent acute rejection in renal transplantation. New England Journal of Medicine 338: 161–165. | |
| Polyclonal antibodies | |
| Brennan DC, Flavin K, Lowell JA et al. (1999) A randomized, double-blinded comparison of thymoglobulin versus ATGAM for induction immunosuppressive therapy in adult renal transplant recipients [published erratum appears in Transplantation 1999; 67 (10): 1386]. Transplantation 67(7): 1011–1018. | |
| Bustami RT, Ojo AO, Wolfe RA et al. (2004) Immunosuppression and the risk of post-transplant malignancy among cadaveric first kidney transplant recipients. American Journal of Transplantation 4(1): 87–93. | |
| Gaber AO, First MR, Tesi RJ et al. (1998) Results of the double-blind, randomized, multicenter, phase III clinical trial of thymoglobulin versus ATGAM in the treatment of acute graft rejection episodes after renal transplantation. Transplantation 66(29): 29–37. | |
| Sirolimus | |
| Ciancio G, Burke GW, Gaynor JJ et al. (2002) A randomized long-term trial of tacrolimus and sirolimus versus tacrolimus and mycophenolate mofetil versus cyclosporine (NEORAL) and sirolimus in renal transplantation. I. Drug interactions and rejection at one year. Transplantation 77(2): 244–251 January 27. | |
| Flechner SM, Goldfarb D, Modlin C et al. (2002) Kidney transplantation without calcineurin inhibitor drugs: a prospective, randomized trial of sirolimus versus cyclosporine. Transplantation 74(8): 1070–1076 October 27. | |
| Larson TS, Dean PG, Stegall MD et al. (2006) Complete avoidance of calcineurin inhibitors in renal transplantation: a randomized trial comparing sirolimus and tacrolimus. American Journal of Transplantation 6(3): 514–522. | |
| MacDonald AS (2001) A worldwide, phase III, randomized, controlled, safety and efficacy study of a sirolimus/cyclosporine regimen for prevention of acute rejection in recipients of primary mismatched renal allografts. Transplantation 71(2): 271–280 January 27. | |
| Meier-Kriesche HU, Steffen BJ, Chu AH et al. (2004) Sirolimus with neoral versus mycophenolate mofetil with neoral is associated with decreased renal allograft survival. American Journal of Transplantation 4(12): 2058–2066. | |
| Tacrolimus | |
| D'Alessandro AM, Kalayoglu M, Pirsch JD et al. (1991) FK506 rescue therapy for resistant rejection episodes in liver transplant recipients. Transplantation Proceedings 23: 2987. | |
| Morrissey PE, Gohh R, Shaffer D et al. (1997) Correlation of clinical outcomes after tacrolimus conversion for resistant kidney rejection or cyclosporine toxicity with pathologic staging by the Banff criteria. Transplantation 27, 63(6): 845–848. | |
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