Figure 114

Summary of strategies for combining immunosuppressive agents. Currently, monotherapy (usually cyclosporine [Csa]) is not used in the United States. Dual therapy (involving cyclosporine or tacrolimus) is used commonly in Europe. Most centers in the United States use triple or quadruple therapy (induction or sequential). Some centers continue the induction with the antilymphocytic biologic agent for a predetermined period (usually 10-14 days), overlapping with the initiation of cyclosporine (or tacrolimus). Alternatively, the biologic agent is discontinued and cyclosporine (or tacrolimus) begun as soon as the graft function reaches a determined threshold, resulting in no overlap of these two agents. In living donor transplants, azathioprine (Aza) is commonly begun a few days before surgery. [5]. FK-506— tacrolimus; MMF—mycophenolate mofetil.

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