Kidney Week 2025 Early Program - Care of Kidney Transplant Candidates and Recipients-Choosing Immunosuppression for Kidney Transplant Recipients

Choosing Immunosuppression for Kidney Transplant Recipients

Video Transcription

Video Summary

A kidney transplant expert reviews immunosuppression choices. For 15 years, most patients have received tacrolimus plus mycophenolate, usually with steroids; steroid withdrawal hasn’t clearly improved major outcomes despite slightly higher rejection. Belatacept offers better long-term kidney function but higher acute rejection rates, so it may be more useful as a later conversion in stable patients, though rejection risk persists. Switching tacrolimus to once-daily Envarsus can reduce peak-related neurotoxicity and tremor with quality-of-life benefits. Alternatives to mycophenolate include mTOR inhibitors (similar efficacy, fewer viral infections but more metabolic/mucosal side effects) or, selectively, azathioprine. Overall: options exist, but changes increase rejection risk and require individualized trade-offs.

Asset Subtitle

Alexander Wiseman

Meta Tag

Module TRX

Speaker Alexander Wiseman

Keywords

Kidney transplant immunosuppression

Tacrolimus mycophenolate steroid regimen

Belatacept conversion and acute rejection risk

Envarsus once-daily tacrolimus neurotoxicity tremor

mTOR inhibitors vs mycophenolate alternatives