[New immunodepressant drugs for the prevention and control of kidney transplant rejection].

The increasing number of kidney transplantations performed yearly in Italy should prompt nephrologists to improve their knowledge in these patients that fall "by default" in the nephrologists' province. In taking on of this task in addition to a skilled clinical and organizational capacity, it demands experience and an updated knowledge of the immunosuppressive drug machinery currently available. Calcineurin inhibitors (cyclosporine and tacrolimus) are well-defined milestones, currently used. Less well known are some recent drugs such as rapamycin and its analogues, mycophenolate mofetil and mycophenolic acid, anti-CD 25 monoclonal antibodies, chimeric and humanized. These drugs are, or they have become, available commercially in the last few years or they are going to be registered in the near future. However, their registration is due to years of usage in the large majority of current immunosuppressive regimens where they can play the role of a primary or an ancillary drug. Other drugs such as FH778, FTY720, anti-CD 20 (rituximab) and anti-CD 52 (alentuzimab) monoclonal antibodies are still undergoing trials in many collaborative phase 2 and 3, studies. Finally, a third group of drugs is targeted at the co-stimulator molecule network and it is an interesting and challenging opportunity for the near future. A detailed knowledge of the overall therapeutic armamentarium is useful in the kidney transplantation field where all drugs, from the beginning to date, must always be kept in mind. The new drugs do not supplant the old drugs. Knowing the pros and cons of each immunosuppressive drug used in the therapeutic management of kidney transplantation is crucial in improving the clinical results in general, and in tailoring the best regimens in different clinical settings pro-posed by kidney recipients today.