Induction agent in low immunological risk: the Indian scenario

Chronic kidney disease (CKD) is a global health problem because of increasing prevalence, high cost of management and risk factor for ischemic heart disease. Renal transplantation remains the current best form of therapy for end stage renal disease (ESRD). Renal transplantation with living kidney donor is better compared to deceased donor transplantation in terms of survival and quality of life. Use of induction agents in renal transplantation has evolved over the years from initial use of muromonab, anti-thymocyte globulins (ATG), and IL-2 blockers to alemtuzumab. Multiple studies have compared these agents in different risk groups and scenarios. There is strong evidence for using ATG compared to IL-2 blockers in high risk group, however, the same does not apply to low risk group. There is a paucity of data regarding the use of induction agents in the Indian sub-continent. The role of induction agents in this population which is prone to opportunistic infections, side effects of drugs and where cost of treatment takes a priority, are not well known especially in low immunological risk group. This review article summarizes the role of various induction agents in different risk groups with relevance to Indian population.