Figure 910

Induction (panel A) and maintenance (panel B) immunosuppression protocols. These immunosuppressive protocols differ from center to center. There are numerous variations, but the essential features are 1) the prednisone dosage is high initially and then reduced to a maintenance dose of 10 to 15 mg/d over 6 to 9 months, and 2) the cyclosporine dosage is 8 to 12 mg/kg/d given as a single or twice daily dose, and dosage is adjusted according to trough plasma and serum blood levels. To maintain immunosuppression provided by cyclosporine and to reduce the incidence of cyclosporine side effects, azathioprine or mycophenolate has also been used with lower dosages of cyclosporine. The results of this triple therapy are excellent, with first-year graft survival greater than 85% reported in most instances and with a substantial number of patients having no rejection at all. Although this type of regimen was the most common, there have been a number of exceptions [2,10]. Recently, mycophenolate mofetil has been approved by the US Food and Drug Administration for prophylaxis of renal transplant rejection [11]. This agent was developed as a replacement to azathioprine for maintenance immunosuppression. FK506 is a new immunosuppressive agent that has been approved by the FDA. FK506 is similar to cyclosporine in its mode of action, efficacy, and toxicity profile. The drug has been used in kidney transplantation. FK506 may be beneficial in renal transplantation as rescue therapy in patients taking cyclosporine who have recurrent or resistant rejection episodes [12-14].

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