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Immunosuppressive strategies to avoid complications: the Achilles' heel of transplantation

Purpose of reviewThe goal of solid organ transplantation has now evolved into minimizing the long-term consequences of immunosuppression. The consequences of immunosuppression include an increased risk of developing diabetes, renal insufficiency, osteoporosis, malignancies, and viral infections, to name but a few. Recent findingsImmunosuppressive protocols that avoid or minimize the use of calcineurin inhibitors hold the promise of better long-term patient outcomes, especially with patients who progress on to dialysis or renal transplantation after organ transplantation. New, aggressive induction protocols have been used in patients with chronic viral infections, such as hepatitis C, without untoward effects on outcomes. SummaryIt is important to appreciate that the long-term benefits of new immunosuppressive strategies have yet to stand the test of time when considering long-term graft survival. Follow-ups to these recent studies should be incorporated and should have similar rates of acute rejection to ensure similar long-term outcomes.