Prior to renal transplant, is immunosuppression required?

From the Guidelines

Yes, immunosuppression is required prior to renal transplant, as it is recommended to start a combination of immunosuppressive medications before, or at the time of, kidney transplantation. According to the KDIGO clinical practice guideline for the care of kidney transplant recipients, a summary published in Kidney International in 2010 1, induction therapy with a biologic agent is recommended as part of the initial immunosuppressive regimen. The guideline suggests that an IL2-RA be the first-line induction therapy, but a lymphocyte-depleting agent may be used instead for patients at high immunologic risk.

The key points to consider are:

• Starting immunosuppression before or at the time of transplant is crucial for preventing rejection and ensuring the success of the transplant
• The choice of immunosuppressive medications and the timing of their administration should be individualized based on the patient's immunologic risk and other factors
• Induction therapy with a biologic agent, such as an IL2-RA, is a recommended part of the initial immunosuppressive regimen, as stated in the guideline 1

In terms of specific medications, the guideline recommends using an IL2-RA as the first-line induction therapy, with options including basiliximab (Simulect) or daclizumab 1. However, the exact choice of medication and dosing regimen should be determined by the patient's healthcare provider based on their individual needs and circumstances.

Overall, the evidence supports the use of immunosuppression prior to renal transplant, with the goal of preventing rejection and ensuring the long-term success of the transplant, thereby reducing morbidity, mortality, and improving quality of life 1.

From the FDA Drug Label

14 CLINICAL STUDIES 14. 1 Kidney Transplantation

Tacrolimus / Azathioprine (AZA) Tacrolimus-based immunosuppression in conjunction with azathioprine and corticosteroids following kidney transplantation was assessed in a randomized, multicenter, non-blinded, prospective trial. All patients received prophylactic induction therapy consisting of an antilymphocyte antibody preparation, corticosteroids, and azathioprine.

The question of whether immunosuppression is required prior to renal transplant is not directly addressed in the provided text. The text discusses immunosuppression regimens following kidney transplantation, but does not provide information on the necessity of immunosuppression prior to the transplant. 2

From the Research

Immunosuppression Prior to Renal Transplant

• The need for immunosuppression prior to renal transplant is a topic of discussion in the medical field, with various studies providing insights into its necessity and effects.
• A study published in 2024 3 found that patients with glomerulonephritis who received pretransplant immunosuppression were not at an increased risk for developing infections after transplantation.
• Another study from 2004 4 reported excellent outcomes in ABO-incompatible living kidney transplantation under pretransplantation immunosuppression with tacrolimus, mycophenolate mofetil, and steroid, without severe infectious complications.

Types of Immunosuppression

• Different types of immunosuppressive drugs are used in renal transplant patients, including calcineurin inhibitors, corticosteroids, and antiproliferative drugs 5.
• The choice of immunosuppressive therapy depends on various factors, such as the time since transplantation, the underlying disease, and the condition of the graft 6.
• Generic tacrolimus and mycophenolate mofetil have been used as primary immunosuppression in renal transplant recipients, with preliminary reports showing effective and safe immunosuppression 7.

Risks and Benefits

• Immunosuppressive therapy is essential to prevent rejection and prolong graft function, but it also carries risks of certain side effects 5.
• The goal of immunosuppressive therapy is to optimize allograft and patient survival while minimizing drug toxicity and complications 6.
• The use of immunosuppressive drugs requires careful consideration of the benefits and risks, as well as individualized treatment plans to maximize efficacy and reduce toxicity 5.