The new era of treatments for kidney transplant recipients

Abstract

Key Points Unmet medical needs in kidney transplantation Increasing access to transplantation for highly sensitized patients. Development of selective lymphocyte-depleting induction therapies that favor a tolerogenic immunological environment following homeostatic reconstitution. Promotion of faster and more complete recovery of kidney function in the immediate post-transplant period. Prevention of acute rejection through CNI-free strategies, enabling stable kidney function, improved adherence, and avoidance of CNI-associated systemic and nephrotoxic long-term adverse effects. Effective treatment of late acute rejection, reducing the risk of graft loss and prolonging graft survival. Novel therapies Protease-induced transient IgG cleavage, targeted depleting agents, complement inhibitors, costimulatory blockers, and selective B- and NK-cell inhibitors are under development. Implications The impact on clinical practice is expected to be substantial, particularly with the chronic use of biologic agents administered either in clinic-based settings or through home self-administration, alongside anticipated improvements in patient and graft survival. Future perspectives The incorporation of these therapies will depend on real-world confirmation of the efficacy and safety observed in clinical trials, regional cost-effectiveness analyses, identification of optimal strategies (including combined or sequential approaches), characterization of patient subgroups most likely to benefit, and integration of patient-reported outcomes and quality of life.