Salvadori M, Tsalouchos A. Innovative immunosuppression in kidney transplantation: A challenge for unmet needs. World J Transplant 2022; 12(3): 27-41 [PMID: 35433332 DOI: 10.5500/wjt.v12.i3.27]
Corresponding Author of This Article
Maurizio Salvadori, MD, Professor, Department of Renal Transplantation, Careggi University Hospital, Largo Palagi 1, Florence 50139, Italy. maurizio.salvadori1@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Mar 18, 2022; 12(3): 27-41 Published online Mar 18, 2022. doi: 10.5500/wjt.v12.i3.27
Innovative immunosuppression in kidney transplantation: A challenge for unmet needs
Maurizio Salvadori, Aris Tsalouchos
Maurizio Salvadori, Department of Renal Transplantation, Careggi University Hospital, Florence 50139, Italy
Aris Tsalouchos, Division of Nephrology, Santa Maria Annunziata Hospital, Florence 50012, Italy
Author contributions: Salvadori M and Tsalouchos A contributed equally to the manuscript; Salvadori M designed the study, performed the last revision and provided answers to the reviewers; Tsalouchos A collected the data from literature; Salvadori M and Tsalouchos A analyzed the collected data and wrote the manuscript.
Conflict-of-interest statement: Salvadori M and Tsalouchos A do not have any conflict of interest in relation to the manuscript, as in the attached form.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maurizio Salvadori, MD, Professor, Department of Renal Transplantation, Careggi University Hospital, Largo Palagi 1, Florence 50139, Italy. maurizio.salvadori1@gmail.com
Received: October 22, 2021 Peer-review started: October 22, 2021 First decision: January 22, 2022 Revised: January 27, 2022 Accepted: March 6, 2022 Article in press: March 6, 2022 Published online: March 18, 2022
Abstract
Due to the optimal results obtained in kidney transplantation and to the lack of interest of the industries, new innovative drugs in kidney transplantation are difficult to be encountered. The best strategy to find the new drugs recently developed or under development is to search in the sections of kidney transplantation still not completely covered by the drugs on the market. These unmet needs are the prevention of delayed graft function (DGF), the protection of the graft over the long time and the desensitization of preformed anti human leukocyte antigen antibodies and the treatment of the acute antibody-mediated rejection. These needs are particularly relevant due to the expansion of some kind of kidney transplantation as transplantation from non-heart beating donor and in the case of antibody-incompatible grafts. The first are particularly exposed to DGF, the latter need a safe desensitization and a safe treatments of the antibody mediated rejections that often occur. Particular caution is needed in treating these drugs. First, they are described in very recent studies and the follow-up of their effect is of course rather short. Second, some of these drugs are still in an early phase of study, even if in well-conducted randomized controlled trials. Particular caution and a careful check need to be used in trials launched 2 or 3 years ago. Indeed, is always necessary to verify whether the study is still going on or whether and why the study itself was abandoned.
Core Tip: Finding new innovative drugs for kidney transplantation is not easy but looking for unmet needs it is possible to find new interesting drugs and opportunities to use in kidney transplantation. Many of these drugs are just at the beginning of their process toward the approval and should be careful checked until the finish of their path. Principal unmet needs are treatment and prevention of delayed graft function, improve the long-term outcomes, desensitization and treatment of acute antibody-mediated rejection. Finding new drugs in these fields results extremely important to face new kind of transplantation as transplant from non-heart beating donor and transplant in ABO incompatibles pairs.
