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2015 ; 5
(3
): 73-80
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Minimization vs tailoring: Where do we stand with personalized immunosuppression
during renal transplantation in 2015?
#MMPMID26421259
Zsom L
; Wagner L
; Fülöp T
World J Transplant
2015[Sep]; 5
(3
): 73-80
PMID26421259
show ga
The introduction of novel immunosuppressive agents over the last two decades and
the improvement of our diagnostic tools for early detection of antibody-mediated
injury offer us an opportunity, if not a mandate, to better match the
immunosuppression needs of the individual patients with side effects of the
therapy. However, immunosuppressive regimens in the majority of programs remain
mostly protocol-driven, with relatively little inter-program heterogeneity in
certain areas of the world. Emerging data showing different outcomes with a
particular immunosuppressive strategy in populations with varying immunological
risks underscore a real potential for "personalized medicine" in renal
transplantation. Studies demonstrating marked differences in the adverse-effect
profiles of individual drugs including the risk for viral infections, malignancy
and renal toxicity call for a paradigm shift away from a "one size fits all"
approach to an individually tailored immunosuppressive therapy for renal
transplant recipients, assisted by both screening for predictors of graft loss
and paying close attention to dose or class-related adverse effects. Our paper
explores some of the opportunities during the care of these patients. Potential
areas of improvements may include: (1) a thorough assessment of immunological and
metabolic risk profile of each renal transplant recipient; (2) screening for
predictors of graft loss and early signs of antibody-mediated rejection with
donor-specific antibodies, protocol biopsies and proteinuria (including close
follow up of adverse effects with dose adjustments or conversions as necessary);
and (3) increased awareness of the possible link between poor tolerance of a
given drug at a given dose and non-adherence with the prescribed regimen.
Altogether, these considerations may enable the most effective use of the drugs
we already have.
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