Yves Vanrenterghem

Immunosuppression and Treatment of Rejection in Renal Transplantation

Since the introduction of Azathioprine combined with corticosteroids in 1962, more than 50,000 kidney allo–grafts have been transplanted in man. It is out of doubt that this chemical immunosuppression has played a significant role in controlling the complex equilibrium between allograft rejection and tolerance, in some cases resulting in longstanding graft acceptance. It is however somewhat surprising that, despite the tremendous work that has been done in the past twenty years in the field of transplantation immunology and immunobiology, the basic immunosuppressive treatment after kidney transplantation has still not been modified. Of the wide range of agents capable of depressing the immune system in vitro, only a handfull have been found to be safe and effective for human use(l). Azathioprine, corticosteroids and to a lesser extend antilymphocyte serum, are still the mainstay of immunosuppression in most transplant centers throughout the world. After all this years we still do not know exactly how they influence the immune system nor do we have a clear idea on optimal timing and dosage, which are mostly empirical and widely variable between different centers: rejection is often the only indication of insufficient immunosuppression, overwhelming infection of oversuppression.