Abstract：
UNASSIGNED: Although early rejection episodes are successfully controlled, the problem of unrecognized production of de novo anti-HLA antibodies and associated chronic rejection still persists.
UNASSIGNED: In addition to the standard induction and maintenance therapy, we present a couple of new drugs as induction (Alemtuzumab), CNI-free protocol (Belatacept, Sirolimus, and Everolimus), and maintenance treatment in transplant patients with various types of malignancies (T cell-targeted immunomodulators blocking the immune checkpoints CTLA-4 and PD1/PDL1) and TMA (aHUS)-eculizumab and IL6 receptor antagonists in antibody-mediated rejection (AMR).
UNASSIGNED: There are a couple of issues still preventing improvement in kidney transplant long-term outcomes with current and anticipated future immunosuppression: patients more susceptible to infection and CNI nephrotoxicity in kidneys obtained from elderly donors and highly sensitized patients with limited chances to get appropriate kidney and a higher risk for late AMR. A lower rate of CMV/BK virus infections has been observed in everolimus-treated patients. Belatacept use has been justified only in EBV-seropositive kidney transplants due to the increased risk of PTLD. Eculizumab upon recurrence of aHUS is a sole cost-effective option. A new IL-6 blocking drug (clazakizumab/tocilizumab) is a promising option for prevention/treatment of AMR. Clinical experience in tailoring immunosuppression for improving as long as possible graft and patient survival is inevitable.
UNASSIGNED: In addition to the standard induction and maintenance therapy, we present a couple of new drugs as induction (Alemtuzumab), CNI-free protocol (Belatacept, Sirolimus, and Everolimus), and maintenance treatment in transplant patients with various types of malignancies (T cell-targeted immunomodulators blocking the immune checkpoints CTLA-4 and PD1/PDL1) and TMA (aHUS)-eculizumab and IL6 receptor antagonists in antibody-mediated rejection (AMR).
UNASSIGNED: There are a couple of issues still preventing improvement in kidney transplant long-term outcomes with current and anticipated future immunosuppression: patients more susceptible to infection and CNI nephrotoxicity in kidneys obtained from elderly donors and highly sensitized patients with limited chances to get appropriate kidney and a higher risk for late AMR. A lower rate of CMV/BK virus infections has been observed in everolimus-treated patients. Belatacept use has been justified only in EBV-seropositive kidney transplants due to the increased risk of PTLD. Eculizumab upon recurrence of aHUS is a sole cost-effective option. A new IL-6 blocking drug (clazakizumab/tocilizumab) is a promising option for prevention/treatment of AMR. Clinical experience in tailoring immunosuppression for improving as long as possible graft and patient survival is inevitable.
摘要：
■尽管成功控制了早期排斥事件，从头产生抗HLA抗体和相关的慢性排斥反应的问题仍然存在.
■除了标准的诱导和维持治疗，我们提出了几种新药作为诱导（阿仑单抗），无CNI协议(Belatacept，西罗莫司,和依维莫司)，以及在抗体介导的排斥反应（AMR）中患有各种类型恶性肿瘤（T细胞靶向免疫调节剂阻断免疫检查点CTLA-4和PD1/PDL1）和TMA（aHUS）-依库珠单抗和IL6受体拮抗剂的移植患者的维持治疗。
■目前和预期的未来免疫抑制仍有一些问题阻碍了肾移植长期结局的改善：从老年供体获得的肾脏中更容易感染和CNI肾毒性的患者和高度敏感的患者，获得适当肾脏的机会有限，晚期AMR的风险更高。在依维莫司治疗的患者中观察到CMV/BK病毒感染率较低。由于PTLD的风险增加，Belatacept的使用仅在EBV血清阳性的肾脏移植中被证明是合理的。aHUS复发后的Eculizumab是唯一具有成本效益的选择。一种新的IL-6阻断药物（clazakizumab/tocilizumab）是预防/治疗AMR的有希望的选择。定制免疫抑制以改善尽可能长的移植物和患者存活的临床经验是不可避免的。
■除了标准的诱导和维持治疗，我们提出了几种新药作为诱导（阿仑单抗），无CNI协议(Belatacept，西罗莫司,和依维莫司)，以及在抗体介导的排斥反应（AMR）中患有各种类型恶性肿瘤（T细胞靶向免疫调节剂阻断免疫检查点CTLA-4和PD1/PDL1）和TMA（aHUS）-依库珠单抗和IL6受体拮抗剂的移植患者的维持治疗。
■目前和预期的未来免疫抑制仍有一些问题阻碍了肾移植长期结局的改善：从老年供体获得的肾脏中更容易感染和CNI肾毒性的患者和高度敏感的患者，获得适当肾脏的机会有限，晚期AMR的风险更高。在依维莫司治疗的患者中观察到CMV/BK病毒感染率较低。由于PTLD的风险增加，Belatacept的使用仅在EBV血清阳性的肾脏移植中被证明是合理的。aHUS复发后的Eculizumab是唯一具有成本效益的选择。一种新的IL-6阻断药物（clazakizumab/tocilizumab）是预防/治疗AMR的有希望的选择。定制免疫抑制以改善尽可能长的移植物和患者存活的临床经验是不可避免的。
