Yabu Julie M, Vincenti Flavio
Department of Medicine, Division of Nephrology, Stanford University Medical Center, Palo Alto, CA 94304, USA.
Adv Chronic Kidney Dis. 2009 Jul;16(4):226-33. doi: 10.1053/j.ackd.2009.04.003.
Kidney transplantation today has excellent short-term outcomes, but long-term graft survival has not improved in a parallel fashion. The goal of immunosuppressive therapy is to balance the beneficial effects of reducing acute rejection while minimizing adverse effects from oversuppression including the development of infections, malignancy, and cardiovascular risk factors. In general, current immunosuppressive protocols use combinations of immunosuppressive agents with different mechanisms of action to maximize efficacy and minimize the toxicity of each drug. During the past decade, there has been a growing interest in identifying regimens that permit the minimization of calcineurin inhibitors or corticosteroids in an attempt to decrease nephrotoxicity and metabolic side effects. The emergence of new immunosuppressive agents and tolerance protocols appear promising as a means to deliver immunosuppression without long-term toxicity. Ultimately, the goal of prescribing immunosuppression is to transition from empiric therapy to one of individualized therapy.
如今，肾移植的短期疗效极佳，但长期移植物存活率并未同步提高。免疫抑制治疗的目标是在降低急性排斥反应的有益效果与将过度抑制带来的不良反应（包括感染、恶性肿瘤和心血管危险因素的发生）降至最低之间取得平衡。一般来说，当前的免疫抑制方案使用具有不同作用机制的免疫抑制剂组合，以最大限度地提高疗效并最小化每种药物的毒性。在过去十年中，人们越来越关注确定能够尽量减少钙调神经磷酸酶抑制剂或皮质类固醇的方案，以试图降低肾毒性和代谢副作用。新的免疫抑制剂和耐受方案的出现，作为一种无长期毒性的免疫抑制手段，似乎很有前景。最终，开具免疫抑制药物的目标是从经验性治疗过渡到个体化治疗。
