What is the role of biologic therapies in immunosuppression after solid organ transplantation?

Updated: Jan 04, 2016
  • Author: Bethany Pellegrino, MD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Biologic agents are polyclonal and monoclonal antibodies and are frequently used in transplantation for induction immunosuppression or treatment of rejection. The 3 antibodies used for induction therapy are the lymphocyte-depleting agents: (1) antithymocyte globulin, (2) alemtuzumab, and (3) basiliximab, which is nondepleting. Historically, immunosuppressant selection was based solely on efficacy for the prevention of rejection. In the current era of transplantation, it is now common practice in the transplant community to select induction therapy based on risk-benefit considerations for each patient.

Polyclonal antilymphocyte antibodies were first successfully used in the 1970s in organ transplantation; however, 10 years later, monoclonal antibodies emerged as a new class of immunosuppressive agents in transplantation, with the potential to target highly specific immune cells responsible for acute rejection. Some have proved their efficacy, such as monoclonal antibodies recognizing CD3- and CD25-positive T cells, and have been extensively studied in clinical trials. Others, such as monoclonal antibodies against CD52 and CD20, are still under investigation; finally, the next challenge is, based on improved understanding of the mechanisms of immune recognition and allograft rejection, to use these monoclonal antibodies either alone or in combination with standard immunosuppressive regimens to control the allogenic response to reach antigen-specific tolerance desired in solid-organ transplantation.

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