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Organ Transplantation

Graft Rejection
    Cellular Mechanisms
    Molecular Mechanisms

Immunsuppressive Agents
    Corticosteroids
    Calcineurine Inhibitors
    Antiproliferative Agents
    Monoclonal Antibodies
    Polyclonal Antibodies
    Side Effects       

Immunotherapy
    Inductive Therapy
    Maintenance Therapy
    Episodic Treatment

Current Areas of Research
    New Drugs
    Drug Efficacy
    Alternative Therapies
        Tolerance
        Tissue Engineering
        Xenotransplantation

Glossary of Terms
References

INDUCTIVE THERAPY

Inductive therapy refers to the prophylactic application of perioperative antibodies in addition to baseline immunosuppression. The goal of the employment of these drugs is to induce hyporesponsiveness in the organ recipient toward the transplanted organ in order to prevent early posttransplant rejection. Ideally, only the T cells that respond to the donor antigen would be inhibited and the rest of the patient's immune system would remain fully functional. Unfortunately, modern medication is not yet so specific, and so the general inhibition of the immune system causes the patient to be more susceptible to infection. In all forms of immunosuppressive therapy, the applied dosages of drugs must balance efficacy of the immunosuppression and risk associated with general impairment of the immune system. The drugs must be strong enough to prevent rejection while protecting the patient from infection at the same time. This balance is complicated by the various interactions of multi-drug therapy; reactions can often be synergistic or lead to the up/down-regulation of drug metabolism.

Initial efforts at inductive therapy utilized polyclonal antibodies, which are nonspecific and can cause allergic reactions, release of pro-inflammatory cytokines, neutropenia, and hemolysis. Today, however, murine monoclonal anti-lymphocyte antibodies, such as OKT3, are often used. OKT3 is subject to the same adverse effects as polyclonal antibodies, but they are less severe because of the increased specificity of the drug. To combat the side effects and generally increased risk of infection (caused by relatively nonspecific suppression of the immune system), antimicrobial agents are a necessary component of inductive therapy.