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Abstract Renal transplantation is considered the treatment of choice for patients with end-stage renal disease, since it offers improved survival and quality of life benefits as compared with dialysis and is considerably less costly. The central issue in organ transplantation remains suppression of allograft rejection. Thus,development of immunosuppressive drugs is the key to successful allograft function. Immunosuppressive agents are used for induction maintenance, and reversal of established rejection. Four classes of immunosuppressive medications are in common use: corticosteroids, calcineurin inhibitors, antimetabolites, and the target- of-rapamycin (TOR) inhibitor, sirolimus. In the maintenance phase, it is customary to prescribe a combination of two or three of these drugs, each from a separate class. The push to withdraw or avoid immunosuppressive medications is a logical progression in the development of organ transplantation. Until recently, the goals of transplantation were focused on short-term survival and minimization of acute rejection episodes. |