Immunosuppression for living donor renal allograft recipients

Living donor kidney transplantation allows immunosuppression individualization based on clinical and immunological criteria. Living donor kidney transplantation allows administration of immunosuppressive drugs days before transplantation, for a better acute rejection prevention. A 3-day course of tacrolimus and a micophenolic acid derivative is recommended. In recipients HLA-identical related to the donor, a tacrolimus-micophenolic acid régimen is recommended. Tacrolimus withdrawal after 6 months may be advisable. In all non-HLA-identical recipients, basiliximab induction is recommended, with the exception of high immunological risk patients, in whom thymoglobulin is a better option. The use of a kidney from an expanded criteria donor might imply a reduction in tacrolimus exposure since the very beginning, to optimize kidney graft function. In general, and depending on immunological risk, steroid withdrawal after the first 3 to 6 months is recommended. ABO-incompatible living donor kidney transplantation is feasible after specific immunoadsorption, gammaglobulins, a dose of rituximab and conventional immunosupression.