New perspectives of immunosuppression

Efficient rejection prophylaxis and excellent short-term results in organ transplantation can not obscure the fact that long-term outcomes have not improved substantially over the last decade with rather constant graft attrition rates beyond the first year. There remains an unmet medical need for new immunosuppressive regimens to improve long-term graft and patient survival while carrying a low side effect burden. Several trials in renal transplant recipients are in the planning stages. In general there are two major strategies to improve outcomes: (a) the constant evolution of new immunosuppressive regimens with the currently approved immunosuppressants, and/or (b) the use of novel immunosuppressants. In this review, we give an overview of the most recent developments of novel immunosuppressive regimes. We show promising new immunosuppressive drugs and new immunosuppressive strategies serving as potential alternative's for calcineurin inhibitor-based regimens. Such regimens should provide similar efficacy and eventually better tolerability or a different side-effect profile with clinical benefits.