Renal transplant: immunosuppression

Example regime

• initial: ciclosporin/tacrolimus with a monoclonal antibody
• maintenance: ciclosporin/tacrolimus with MMF or sirolimus
• add steroids if more than one steroid responsive acute rejection episode

Ciclosporin

• inhibits calcineurin, a phosphotase involved in T cell activation

Tacrolimus

• lower incidence of acute rejection compared to ciclosporin
• also less hypertension and hyperlipidaemia
• however, high incidence of impaired glucose tolerance and diabetes

Mycophenolate mofetil (MMF)

• blocks purine synthesis by inhibition of IMPDH
• therefore inhibits proliferation of B and T cells
• side-effects: GI and marrow suppression

Sirolimus (rapamycin)

• blocks T cell proliferation by blocking the IL-2 receptor
• can cause hyperlipidaemia

Monoclonal antibodies

• selective inhibitors of IL-2 receptor