Immunomodulation dans la greffe rénale : ce qui a changé en 20 ans

Calcineurin inhibitors are the cornerstone of immunosuppression in kidney transplantation, whose prognosis is now excellent, with more than 95% of patients with a functional graft at year 1. Thus, transplantation has become the best treatment of end-stage renal disease. Even high-immunological risk patients may now be transplanted, after the administration of sophisticated combinations of immunomodulating drugs. Acute rejection and infectious complications are now well prevented. Therefore, the central issue in kidney transplantation is now to ensure the long-term survival of the patient, and the long-term function of the graft. A better comprehension of the mechanisms of the non-immune toxicity of immunosuppressants, and of the host-graft adaptation, is needed.