Cheguevara Afaneh, Meredith J Aull, Sebastian Schubl, David B Leeser and Sandip Kapur
Kidney transplantation remains the most effective modality for the treatment of end-stage renal disease. The development of induction therapy has significantly reduced the incidence of acute rejection within the first six months following kidney transplantation. As a result, induction therapy is typically administered in the majority of kidney transplants. Moreover, early graft function has also improved with the advent and routine administration of induction therapy. Effective induction therapy has also expanded the donor pool as it allows for more effective utilization of marginal donor kidneys including expanded criteria donors and donors after cardiac death. It may also benefit higher immunologic risk recipients such as highly sensitized, African American, and repeat transplant patients. Poly- and monoclonal antibody agents are available for use as induction agents, including rabbit Anti-thymocyte globulin, interleukin-2 receptor antagonists, and alemtuzumab each of which have proven efficacy but have discrete advantages and disadvantages. Tailoring induction therapy to individual patient profiles provides the best opportunity for both short and long-term outcomes of the patient and allograft. Moreover, we explore the role of induction therapy with long-term steroid avoidance immunosuppression regimens in modern kidney transplantation. Overall, we review the safety and efficacy of this important group of induction agents and discuss an approach to tailoring their use for specific patients undergoing kidney transplantation.
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