%0 Journal Article
%T Pharmacotherapeutic options for the prevention of kidney transplant rejection: the evidence to date.
%A Spasovski G
%A Trajceska L
%A Rambabova-Bushljetik I
%J Expert Opin Pharmacother
%V 23
%N 12
%D Aug 2022
%M 35835450
%F 4.103
%R 10.1080/14656566.2022.2102418
%X <B>UNASSIGNED: </B>Although early rejection episodes are successfully controlled, the problem of unrecognized production of de novo anti-HLA antibodies and associated chronic rejection still persists.<BR><B>UNASSIGNED: </B>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).<BR><B>UNASSIGNED: </B>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.