Less nephrotoxic immunosuppressives may reduce renal morbidity, but until now cyclosporin A or tacrolimus are indispensable to preserve graft function.

  1. In the early post-transplantation phase, the nephrotoxicity of these agents may be aggravated by haemodynamic, operation related instability or concomitant use of other nephrotoxic agents. As induction therapy with newer monoclonal agents and addition of mycophenolate mofetil are available, critical reappraisal of the moment of introduction of cyclosporin or tacrolimus and the targeted levels may reduce this early toxicity. During long-term follow-up, careful monitoring of trough cyclosporin or tacrolimus levels, withdrawal of these agents or the use of calcium-entry-blockers are possible tools.
  2. Early diagnosis and adequate therapy of cyclosporin-induced hypertension is likely to be important as in native kidney diseases and renal transplantation hypertension is associated with worse renal prognosis.
  3. Whether these possible preventive measures will result in relevant renoprotection in non-renal transplant recipients remains, however, to be investigated.