Newer immunosuppressive drugs in organ transplantation: improving outcomes.

The advent of new immunosuppressive drugs is allowing renal physicians to individualize immunosuppressive therapy. A combination of drugs with lesser toxicities especially lower nephrotoxicity with better renal function should result in longer graft and patient survival and reports are already beginning to show that. The emphasis should be on minimizing toxicity of individual drugs and hopefully this should allow to lessen or prevent morbidity associated with the older immunosuppressive drugs. The areas of interest would be minimizing the calcineurins and steroids with the increasing use of the monoclonal receptor antibodies, proliferation signal inhibitors and mycophenolate. The only deterrent seems to be the prohibitively exorbitant cost of the newer immunosuppressive drugs. Various generic forms available in the country has allowed the cost containment to some extent. However what needs to be done is to develop evidence for various cost effective protocols for live donor transplants.