Immunosuppression

Immunosuppression for renal and pancreatic transplantation is achieved through multiple drug regimens, usually based on an induction antibody, calcineurin inhibitor, antiproliferative agent and steroid. Selection of the most appropriate drug regimen depends on the risk of immunological rejection and predisposition to specific drug toxicities. The immunosuppressive drugs have a narrow therapeutic index and require careful monitoring. Therapeutic drug monitoring is used, routinely, for ciclosporin, tacrolimus, sirolimus and everolimus, with some data supporting measurement of mycophenolic acid. A number of key drug interactions affect immuosuppressive drug exposure, and a detailed knowledge of their pharmacology is essential to allow safe prescribing. Acute rejection is treated by short-term intensification of immunosuppression.

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