Strategies to minimize immunological and nonimmunological risk factors in the renal transplant population.

Abstract

To improve long-term outcome after renal transplantation, attention should be placed on the tailored use of immunosuppressive regimens that have a more favorable impact on the immunological and nonimmunological risk profiles of an individual recipient. Tacrolimus is widely used for maintenance and rejection immunosuppression in solid organ transplantation, and compared with cyclosporine, its use in renal transplantation is associated with a reduced incidence and severity of acute rejection and a more positive effect on known cardiovascular risk factors. Recent experience with tacrolimus-based therapy has demonstrated an improved lipid profile and lower arterial blood pressure, with less requirement for lipid-lowering and antihypertensive medication compared with cyclosporine, without significantly increasing the risk of long-term insulin-dependent posttransplant diabetes mellitus. The advantageous effects of tacrolimus on both immunological and nonimmunological risk factors offer potential benefits for long-term graft function and survival.