The addition of novel immunosuppressive agents and transfusion regimens to the therapy of human kidney transplantation has significantly improved the outcome of transplants that are performed today. At its inception, kidney transplantation quickly gained a foothold as an effective treatment modality for end-stage kidney disease because of the availability of living related donors and the drug azathioprine. That the procedure has established itself as acceptable, thus allowing for the development of the interventions to be discussed here, was largely due to our gradual understanding of how to use azathioprine safely, coupled with the fact that a viable alternative for prolonging life was not then available. When chronic hemodialysis emerged as a safe, effective, and readily available therapeutic regimen, the use of less noxious drugs and procedures in transplant recipients was virtually mandated. The interventions that subsequently gained a place in transplantation then were those that had relatively little down-side risk for the patient using azathioprine and corticosteroids as the reference standard. This procedural approach largely reduced the number of experimental immunosuppressive regimens initially deemed worthy of sustained clinical investigation. Often, however, the risk-benefit ratio approach proved to be difficult to assess. Indeed, the finding of associated side effects with dramatically effective drugs such as cyclosporin have presented new problems and decisions for the investigator to cope with.
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine