Evolution of Immunosuppressive Agents in Renal Transplantation: An Updated Review

Suppression of allograft rejection is the central issue in renal transplantation (RT). Thus, development of immunosuppressive agents is the key for successful allograft function. Immunosuppression agents in RT have evolved over the last six decades beginning with total lymphoid irradiation to the currently available immunosuppressive strategies, which have significantly reduced the incidence of acute rejection episodes and improved short-term graft and patient outcomes. However their use is associated with long-term graft dysfunction, hypertension, hyperlipidaemia, diabetes mellitus, infections and malignancies. Chronic antibody-mediated rejection and chronic allograft dysfunction still remain the major problems, often leading to graft loss and shortened long-term graft survival. Immunosuppressive agents are used for induction, maintenance and reversal of established rejection. The use of multidrug regimen tailored to the immunological risk of patient and adverse-effect profile of the drug provides the optimum outcomes. This review focuses on the evolution of immunosuppression agents used in RT over last six decades and highlights the newer agents under investigation.