Complications of Kidney Transplantation: Effects of Over-Immunosuppression

Kidney transplantation is a relatively young field within medicine which continues to experience rapid advances in several areas. The number of immunosuppressive medications available to prevent and treat immunologic rejection of the transplanted organ has increased significantly since the late 1990’s, however, there continues to be a great need for developing novel, less toxic medications. The fine balance between overand underimmunosuppression is difficult to achieve in many transplant recipients, particularly as candidacy for kidney transplantation has expanded to include the elderly, patients with HIV and/or Hepatitis C infection, and sensitized transplant candidates. The relationship between infection and rejection remains closely intertwined, and can be a vicious cycle, with reduction of immunosuppression to manage infection potentially triggering rejection, and increased immunosuppression in the setting of rejection potentially leading to infectious complications. This chapter will focus on post-transplant complications resulting from overimmunosuppression, specifically infection and malignancy.