Thai Transplant Care Practice Guideline on Immunosuppressive Therapy for Adult Kidney Transplantation.

Abstract

The Thai Transplantation Society developed these clinical practice guidelines to establish a comprehensive standard for immunosuppressive therapy in adult kidney transplantation. While rooted in evidence-based medicine, the objective of this document extends beyond local application, serving as a practical model for low-to-middle-income countries, particularly within the Asia-Pacific and Southeast Asian regions, where specific genetic profiles and resource limitations require tailored management strategies. This publication addresses a critical need in the field, as there has been no updated comprehensive international consensus on immunosuppression since the KDIGO Clinical Practice Guideline in 2009, over 17 years ago. These guidelines bridge this gap by synthesizing modern clinical data with practical applicability. The scope of the guidelines is extensive, covering all aspects of immunosuppression usage including induction, maintenance, therapeutic drug monitoring, and the treatment of rejection. Uniquely, this document addresses specific challenges relevant to resource-limited settings, offering protocols for cost reduction through the use of generic drugs and the co-administration of cytochrome P450 3A4 and 3A5 inhibitors to minimize dosage requirements. Furthermore, it provides distinct guidance for immunosuppression in special clinical settings, including management during periods of fasting, pregnancy, and malignancy. This guideline ultimately benefits clinicians by offering a pragmatic, updated reference that balances therapeutic efficacy with economic sustainability.