Are there resources that outline essential medications to have on a hospital's inpatient and outpatient infusion formulary to support a kidney transplant program?

Comment by InpharmD Researcher

Table 1 is synthesized from institutional transplant protocols and provincial transplant guidelines and presents a framework of essential inpatient and outpatient parenteral therapies supporting induction, maintenance bridging, rejection, and infection management in kidney transplant programs. The table distinguishes core, commonly protocolized infusion agents from conditional therapies based on program scope, immunologic risk, and specialized services. This is not intended to be exhaustive and should be adapted based on institutional practice patterns and program scope. Highly specialized rescue therapies (e.g., imlifidase, eculizumab, bortezomib, or antifungal salvage agents) used selectively at advanced centers are not included.

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Background

Induction therapy options in kidney transplantation include several distinct pharmacologic strategies used to mitigate early rejection risk. IL-2 receptor antagonists, most commonly basiliximab, provide selective, non-depleting immunosuppression and are typically used in standard-risk recipients due to their favorable safety profile. Polyclonal lymphocyte-depleting antibodies, such as rabbit antithymocyte globulin (rATG) and ATG-Fresenius, produce broader T- and B-cell depletion and are preferentially used in high-immunologic-risk patients, those at risk for delayed graft function, or in steroid-minimization protocols, though at the cost of increased infection and malignancy risk. Alemtuzumab, a CD52-directed monoclonal antibody, provides prolonged lymphocyte depletion and has been associated with lower acute rejection rates but carries a higher infectious risk and variable effects on donor-specific antibody development. In ABO-incompatible and HLA-sensitized transplantation, induction therapy is combined with desensitization strategies such as plasma exchange, rituximab, and intravenous immunoglobulin. Imlifidase, a novel IgG-cleaving enzyme, facilitates transplantation in highly sensitized or crossmatch-positive recipients by rapidly removing circulating donor-specific antibodies, although antibody rebound and early antibody-mediated rejection remain important considerations. [1]

Maintenance immunosuppression following kidney transplantation typically consists of triple therapy with a calcineurin inhibitor (CNI; tacrolimus or cyclosporine), an antiproliferative agent (most commonly mycophenolate), and corticosteroids. Tacrolimus-based regimens are preferred over cyclosporine due to lower rates of acute rejection and graft loss, though intrapatient pharmacokinetic variability and metabolic adverse effects remain important considerations. Belatacept, a selective costimulation blocker, has emerged as a key CNI-sparing alternative and is associated with superior long-term renal function and reduced chronic allograft injury despite higher early acute rejection rates. A 2022 multidisciplinary consensus report endorsed by major transplant societies supports tacrolimus as the preferred CNI across solid organ transplantation, recognizes extended-release formulations as equivalent to immediate-release forms, affirms the central role of mycophenolate derivatives, and emphasizes steroid minimization when feasible. The consensus also acknowledges belatacept and mTOR inhibitors as appropriate alternatives in selected patients to reduce CNI-related toxicity, reinforcing the need for individualized maintenance immunosuppression strategies. [1], [2]

A 2023 publication offers a detailed review of current therapies for kidney transplant rejection, focusing on acute T-cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR). The primary treatment for TCMR involves corticosteroids, specifically intravenous methylprednisolone, which is often followed by an oral prednisone taper. In severe or steroid-resistant cases of TCMR, T-cell-depleting agents such as thymoglobulin are recommended, which target various receptors on T cells to induce lymphocyte depletion through complement-dependent lysis and apoptosis. For ABMR, the publication highlights the significant role of antibody interaction with graft endothelial cells, often treated with plasmapheresis to remove circulating donor-specific antibodies, although the efficacy of this method is debated. The review discusses additional therapies, including intravenous immunoglobulins (IVIG), anti-CD20 antibodies like rituximab, complement inhibitors (eculizumab), and proteasome inhibitors (bortezomib), each with variable efficacy in managing ABMR. The management decisions are underscored by the necessity to assess the timing of the rejection episode and the presence of chronic changes, aiming to optimize immunosuppression and address adherence issues. [3]

Post-transplant infectious complications in kidney transplantation involve viral, bacterial, and fungal pathogens, with management largely guided by the type and severity of infection. Epstein-Barr virus-associated post-transplant lymphoproliferative disorder is primarily managed with immunosuppression reduction, with rituximab, chemotherapy, or radiation used as indicated. Cytomegalovirus is treated with oral valganciclovir or intravenous ganciclovir in severe cases. BK virus infection and nephropathy are managed mainly through immunosuppression reduction, with adjunctive therapies such as intravenous immunoglobulin, leflunomide, or cidofovir used selectively. Clostridioides difficile infection is treated with oral vancomycin or fidaxomicin, with high-dose vancomycin plus intravenous metronidazole reserved for fulminant disease, and bezlotoxumab considered for recurrence prevention. Fungal infections, including blastomycosis, coccidioidomycosis, and histoplasmosis, are typically treated with lipid-formulation amphotericin for severe disease, followed by step-down azole therapy, whereas mild cases may be managed with primary azole therapy. [4]

References: [1] Spasovski G, Trajceska L, Rambabova-Bushljetik I. Pharmacotherapeutic options for the prevention of kidney transplant rejection: the evidence to date. Expert Opin Pharmacother. 2022;23(12):1397-1412. doi:10.1080/14656566.2022.2102418
[2] Nelson J, Alvey N, Bowman L, et al. Consensus recommendations for use of maintenance immunosuppression in solid organ transplantation: Endorsed by the American College of Clinical Pharmacy, American Society of Transplantation, and International Society for Heart and Lung Transplantation: An executive summary. Pharmacotherapy. 2022;42(8):594-598. doi:10.1002/phar.2718
[3] Alasfar S, Kodali L, Schinstock CA. Current Therapies in Kidney Transplant Rejection. J Clin Med. 2023;12(15):4927. Published 2023 Jul 27. doi:10.3390/jcm12154927
[4] Agrawal A, Ison MG, Danziger-Isakov L. Long-Term Infectious Complications of Kidney Transplantation. Clin J Am Soc Nephrol. 2022;17(2):286-295. doi:10.2215/CJN.15971020
Literature Review

A search of the published medical literature revealed 1 study investigating the researchable question:

Are there resources that outline essential medications to have on a hospital's inpatient and outpatient infusion formulary to support a kidney transplant program?

Level of evidence

B - One high-quality study or multiple studies with limitations  Read more→



Please see Table 1 for your response.


Inpatient essential parenteral medication list - kidney transplant service*
Medication Primary use Typical dosing and administration Key administration notes Core vs conditional
Methylprednisolone IV Induction immunosuppression 2 mg/kg IV once on call to OR, then 1 mg/kg IV every 12 hours for 48 hours starting POD0 (total 4 doses) Round to the nearest 5 mg Core
Basiliximab IV Induction immunosuppression (low to standard risk) 20 mg IV on call to OR and 20 mg IV on POD4 Fixed dosing Core
Rabbit antithymocyte globulin (ATG) IV Induction immunosuppression (high risk) Initial dose usually 1 mg/kg or less, then 1.5 mg/kg IV daily; cumulative dose approximately 3 to 5 mg/kg Adjust dose based on WBC and platelet counts Core
Rabbit antithymocyte globulin (ATG) IV High immunologic risk induction 1.5 mg/kg IV preop or intraop, then daily up to cumulative 7.5 mg/kg (may extend to 10 mg/kg) Adjust based on CBC and immunologic risk Conditional
Rabbit antithymocyte globulin (ATG) IV Administration parameters Central line: ≤125 mg in 250 mL NS over 8 hours; >125 mg in 500 mL NS over 12 hours. Peripheral line: 500 mL NS over 12 hours Premedicate with methylprednisolone, acetaminophen, and diphenhydramine for at least the first two doses Core
Methylprednisolone IV (pulse) Suspected or confirmed rejection 500 to 1000 mg IV daily for 3 days or 5 mg/kg IV daily for 3 days Followed by oral prednisone taper Core
Rabbit antithymocyte globulin (ATG) IV Steroid-resistant or severe rejection Initial dose usually 1 mg/kg or less, then 2 mg/kg IV daily; cumulative dose approximately 5 to 6 mg/kg Same CBC-based hold and dose reduction criteria Core
Belatacept IV Maintenance immunosuppression (CNI avoidance or conversion) Not specified. Dosing per institutional protocol EBV-seropositive recipients only Conditional
Alemtuzumab IV Induction or rejection therapy (off-label) Dosing per institutional protocol Reserved for selected patients due to prolonged lymphocyte depletion Conditional
Rituximab IV Antibody-mediated rejection or desensitization Dosing per institutional protocol Requires premedication and infusion reaction monitoring Conditional
Tacrolimus IV (continuous infusion) Temporary maintenance when oral not tolerated Approximately one-third of the total daily oral dose administered as continuous IV infusion

Continuous infusion; titrate based on trough concentrations

Core
Mycophenolate mofetil IV Maintenance immunosuppression when oral not tolerated IV-to-oral conversion 1:1 Administered every 12 hours Core
Desmopressin (DDAVP) IV Renal biopsy bleeding risk mitigation 20 mcg IV once, administered 30 to 60 minutes prior to biopsy One-time dose Core
Cefazolin IV Perioperative surgical prophylaxis 1 to 3 g IV once on call to OR (<80 kg 1 g, >80 kg 2 g, >120 kg 3 g) Standard perioperative prophylaxis Core
Vancomycin IV Perioperative prophylaxis alternative 15 mg/kg IV once preop, rounded to nearest 250 mg Used for IgE-mediated beta-lactam allergy or MRSA colonization Core
Dalteparin SC Venous thromboembolism prophylaxis 5000 units SC daily; 2500 units if <50 kg; 7500 units if >100 kg Typically started several days post-transplant Core
Outpatient infusion and injectable medication list - kidney transplant service*
Medication Primary outpatient use Typical dosing and administration Key notes Core vs conditional
Belatacept IV Maintenance immunosuppression Initial and maintenance dosing per institutional protocol Requires EBV seropositivity and infusion clinic infrastructure Conditional
Rituximab IV Antibody-mediated rejection or desensitization Dosing per institutional protocol Commonly used in ABO-incompatible or highly sensitized recipients Conditional
Intravenous immunoglobulin (IVIG) Antibody-mediated rejection or desensitization Dosing per institutional protocol Often used in combination with plasmapheresis Conditional
Methylprednisolone IV (pulse) Rejection treatment in selected patients 500 to 1000 mg IV daily for 3 days or 5 mg/kg IV daily for 3 days Site of care depends on clinical stability Core
Rabbit antithymocyte globulin (ATG) IV Treatment of rejection Initial dose usually 1 mg/kg or less, then 2 mg/kg IV daily; cumulative dose approximately 5 to 6 mg/kg Requires close laboratory monitoring Core
Tacrolimus IV (continuous infusion) Bridge therapy when oral not tolerated Approximately one-third of the oral dose as a continuous infusion

Typically short-term use; transition to PO as soon as tolerated

Core
Mycophenolate mofetil IV Maintenance immunosuppression when oral not tolerated IV-to-oral conversion 1:1 Transition to oral as soon as feasible Core
Filgrastim (G-CSF) SC Post-transplant neutropenia Dosing per institutional protocol Used for drug-induced or CMV-related neutropenia Core
Ganciclovir IV Treatment of CMV disease or viremia Dosing per institutional protocol Used when oral valganciclovir is not appropriate Core
Pentamidine inhalation Pneumocystis prophylaxis Monthly inhalation for up to 1 year when other options not appropriate Requires specialized administration Conditional 

*Detailed preparation, compatibility, and infusion requirements are governed by institutional pharmacy procedures and manufacturer labeling.

Abbreviations: AMR = antibody-mediated rejection; ATG = antithymocyte globulin; CBC = complete blood count; CMV = cytomegalovirus; CNI = calcineurin inhibitor; DDAVP = desmopressin; EBV = Epstein–Barr virus; G-CSF = granulocyte colony-stimulating factor; HBIG = hepatitis B immune globulin; IgE = immunoglobulin E; IV = intravenous; MRSA = methicillin-resistant Staphylococcus aureus; NS = normal saline; OR = operating room; POD = postoperative day; PO = oral; SC = subcutaneous; WBC = white blood cell count

References:
[1] Adapted from: BC Transplant Provincial Health Services Authority. Medication Guidelines for Solid Organ Transplant. Updated July 2025. Accessed January 5, 2026. https://www.transplant.bc.ca/Documents/Health%20Professionals/Clinical%20guidelines/AMB.03.007.pdf
[2] St. Michael’s Unity Health Toronto. ​​Kidney Transplant Program Post-Transplant Medication Tip Sheet for Nephrology Residents & Fellows. Updated August 2024. Accessed January 5, 2026. https://www.smhneph.ro/content/manuals/smh/Kidney-Transplant-Medications-Tip-Sheet-Aug-2024.pdf
[3] London Health Sciences Centre. Multi-Organ Transplant Program. Immunosuppressive Regimen for Kidney Transplant Recipients. Updated March 13, 2020. Accessed January 5, 2026. https://www.lhsc.on.ca/media/9684/download
[4] Health Plan of San Joaquin. Medication Coverage Policy. Pharmacy and Therapeutics Advisory Committee. Updated September 14, 2021. Accessed January 5, 2026. https://www.hpsj.com/wp-content/uploads/2021/11/Immunology-Transplant.pdf