Note on sources: The articles in this report are based on the reference tables in the 2004 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the tables and figures included here; other tables from the Annual Report that serve as the basis for this article include the following: Tables 5.6a–d, 6.6a–d, 7.6a–d, 8.6a–d, 9.6a–d, 10.6a–d, 11.6–d, 12.6a–d and 13.6a–d. All of these tables are also available online at http://www.ustransplant.org.
Immunosuppression: evolution in practice and trends, 1993–2003
Article first published online: 10 MAR 2005
American Journal of Transplantation
Volume 5, Issue 4p2, pages 874–886, April 2005
How to Cite
Shapiro, R., Young, J. B., Milford, E. L., Trotter, J. F., Bustami, R. T. and Leichtman, A. B. (2005), Immunosuppression: evolution in practice and trends, 1993–2003. American Journal of Transplantation, 5: 874–886. doi: 10.1111/j.1600-6135.2005.00833.x
Funding: The Scientific Registry of Transplant Recipients (SRTR) is funded by contract number 231-00-0116 from the Health Resources and Services Administration (HRSA), US Department of Health and Human Services. The views expressed herein are those of the authors and not necessarily those of the US Government. This is a US Government-sponsored work. There are no restrictions on its use.
- Issue published online: 10 MAR 2005
- Article first published online: 10 MAR 2005
- Antirejection treatment;
- induction therapy;
- maintenance immunosuppression;
Immunosuppression trends for solid organ transplantation have undergone a perceptible shift over the past decade. This period is of interest because it was during this time that the Food and Drug Administration (FDA) expanded the variety of medications to allow for alternatives in immunosuppressive management. An organ-by-organ review of SRTR data identifies several important trends. Antibody induction continues to be used for the majority of kidney (70%), simultaneous pancreas-kidney (SPK, 79%) pancreas after kidney (PAK, 74%), and intestine recipients (74%). It is used for under half of thoracic organ recipients and remains uncommon for liver transplant recipients (20%). The type of antibody preparation utilized has shifted from muromonab-CD3 and horse ATG to rabbit ATG and monoclonal anti-IL-2 receptor antagonists. Calcineurin inhibitors continue to be used for maintenance immunosuppression for most recipients, although there has been a shift from cyclosporine to tacrolimus. A clear transition is apparent in the choice of antimetabolite from azathioprine to mycophenolate mofetil. Although corticosteroids continue to be used as maintenance immunosuppression for most recipients prior to discharge, there is evidence that efforts of steroid avoidance protocols are having an impact across all organs, as slight decreases in their use have been observed.