2.2. Immunosuppression

Initially, the immunosuppressive regimen consisted of a calcineurin inhibitor (CNI), azathioprine, and a corticosteroid without an induction regimen. However, the immunosuppressive regimen changed during the study period. Currently, the regimen includes a CNI (tacrolimus or cyclosporine), mycophenolic acid, and a corticosteroid. Alternatively, in the case of patients with immunological risk factors, such as highly sensitized individuals or those with previous graft loss due to rejection, and those who wish to avoid the long-term use of steroids, an induction regimen of rabbit antithymocyte globulin (Thymoglobulin; Genzyme, Cambridge, MA) is administered. The changes in the immunosuppressive regimen are shown in Fig. ​Fig.11.

Immunosuppressive regimen during 4000 kidney transplantation (A) induction agent, (B) calcineurin inhibitor, and (C) antimetabolite. ATG = anti-thymocyte globulin, IL-2 R Ab = interleukin-2 receptor antibody, m-TORI = m-TOR inhibitor, MMF = mycophenolate mofetil, MPA = mycophenolic acid.