Immunosuppression used in organ transplantation

Immunosuppressive treatment is indispensable and is a key condition for the success of transplantation. The drugs used as immunosuppression mainly target T cells.

Three types of treatment are distinguished :

Inductive therapy: Prescribed at the time of transplantation to allow the acceptance of the graft.

antibody therapy: ATG (rabbit, horse), anti-CD3, anti-IL2R (Simulect, Zenapax), anti CD52
Glucocorticoid

Maintenance therapy: Given lifelong and is necessary to maintain graft acceptance.

calcineurin inhibitor: Cyclosporine A, Tacrolimus
antiproliferative: Azathioprine, Mycophenolate mofetil, , anti-CD3
Others: sirolimus

Episodic treatment: Given to treat acute rejection episods.

antibody therapy: ATG, anti-CD3,
Immunoglobulin: IVIg,
plasmapheresis (plasma exchange)
Glucocorticoid (i.v. push)

Complications due to immunosuppression

Because immunosuppression diminish immune defenses, bacterial, fungal and viral infections are usually a severe post transplant problem. In medium and long term, immunosuppressive treatment may facilitate the developpment of tumor, particularily of skin and lyphoid system. Direct toxicity of immunosupressive drugs may lead to renal or/and hepatic deficiency. Balance between an efficiency immunosuppressive treatment that avoid graft rejection and a non-invasive treatment is the goal to reach.