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Immunomodulatory and other strategies to reduce the immunosuppressive burden: lessons from all transplantation Edward Geissler

University Hospital Regensburg, Regensburg, Germany

The latest evidence indicates that transplant survival over the long term has not appreciably improved over the past decade, especially for kidney and liver transplantation. Toxicities associated with general immunosuppressive drugs take a toll on allografts, and the long term high immunosuppression levels increase the risk for infections and malignancy in transplant recipients, all contributing to the lack of improvement observed in transplant survival. Well aware of this problem, the transplant research community is constantly in search of new approaches to lower maintenance pharmacological immunosuppression. Establishing donor chimerism in recipients is one approach aimed at decreasing the need for immunosuppression. Immune cell depletion is another strategy that has shown some promise towards minimizing strong immunosuppressant use. Most recently, preclinical research and early clinical trial work suggest that introducing regulatory cell populations near the time of transplantation may provide a new tool to control the specific anti-donor immune response, with the aim to lower, but not completely eliminate, maintenance immunosuppression. In this talk, all these strategies will be presented and discussed.