Introduction: Renal transplant immunosuppression is a vital component of organ transplantation, specifically aimed at preventing the recipient's immune system from rejecting the transplanted kidney. However, the pursuit of an ideal immunosuppressive regimen persists, one that not only limits toxicity but also extends the functional life of the graft. Hence, a nationwide survey was conducted to delve into the current clinical opinions surrounding immunosuppressive strategies, offering a comprehensive overview of both established regimens and therapeutic moieties in development.
Methods: This survey employs a questionnaire-based cross-sectional study design to comprehensively assess the current state of renal transplant immunosuppression and 44 reputed Transplant Institutes had been selected based upon their clinical expertise, repute and involvement in managing renal transplant patients.
Results: The study primary outcome indicates a significant variability in the reported progression rates of chronic Kidney disease stage III patients to kidney transplantation, ranging from 5 - 10% to over 20% as opined by 77% of the surveyed participants. The widespread use of induction suggests a nuanced approach in tailoring immunosuppression to specific transplant scenarios and as opined by >89% Doctors, they use various induction agents in >50% of the patients. The study provides valuable insights into Tacrolimus dosing during maintenance phase as >51% of the participants prefer 0.075 mg/kg/day of Tacrolimus and the desired Tacrolimus blood levels during the maintenance phase is 5 – 8 ng/ml as suggested by >83% of the responders. Surprisingly, >54% of participants were of the opinion to use Mycophenolate Sodium alternatively, in >70% of the patients. Moreover, >54% of participants use Everolimus in only <5% of the patients. The study also highlights the common use of anti-viral agents, particularly Valganciclovir, and the exploration of newer options like Alemtuzumab and Anti-Thymocyte Globulin (ATG) biosimilar.
Conclusion: In conclusion, the primary outcomes of the study contribute significantly to the understanding of current practices in renal transplant immunosuppression which further indicate a forward-looking perspective in refining immunosuppressive strategies and addressing emerging challenges in renal transplant care and collectively shaping the trajectory of future research and innovations in renal transplantation, aiming for improved patient outcomes and personalized care.