Fast Five Quiz: Immunosuppression for Kidney Transplantation

Ron Shapiro, MD


October 22, 2021

Figure 1. A donor human kidney prior to a transplant operation. The healthy kidney is then transplanted into a patient with defective kidneys. This kind of transplant is the most common and successful type of organ transplant operation.

Kidney allograft biopsy should be performed for all kidney recipients with declining kidney function of unknown cause. However, all extrinsic causes should be excluded first before proceeding to biopsy.

Reduction, withdrawal, or replacement of the calcineurin inhibitor should be considered if calcineurin inhibitor toxicity is identified in a kidney biopsy. Although data are scarce on the potential benefits of using an mTOR inhibitor in this setting, this medication class may be used to replace the calcineurin inhibitor in patients with chronic allograft injury, an estimated glomerular filtration rate > 40 mL/min/1.73 m2, and urine total protein excretion < 500 mg/g creatinine (or equivalent proteinuria by other measurements).

In addition, graft preservation requires control of blood pressure, treatment of hyperlipidemia, and management of diabetes.

Learn more about the management of chronic kidney allograft injury.

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