# Transplant Immunosuppression: Balance Rejection and Toxicity

Graft function, proteinuria, infection surveillance, preventive care, cardiovascular risk, and quality of life remain important after the early transplant period.

![Infographic: Transplant Immunosuppression: Balance Rejection and Toxicity](https://urinenephrology.org/visual-reference/images/student-transplant-immunosuppression.png?v=20261003c)

## Complementary immune targets

Induction and maintenance regimens suppress different parts of the immune response. The combination reflects rejection risk, organ function, and treatment history.

## Do not label all graft dysfunction rejection

Check volume, infection, obstruction, vascular problems, drug exposure, adherence, and recurrent disease. Review urine findings and ultrasound when indicated. A creatinine rise may need biopsy, but increasing immunosuppression before considering infection or obstruction can worsen the wrong problem.

## A trough needs timing and interaction history

For tacrolimus monitoring, verify that blood was drawn at the intended predose trough and record the last dose, formulation, diarrhea, and interacting medicines. A mistimed level should not trigger an automatic dose change. Use the transplant program’s target for the posttransplant phase and immunologic risk.

## Coordinate adjustments

Changes should be made through the transplant team with attention to rejection risk, infection, malignancy, metabolic effects, and pregnancy considerations.

## Solve adherence barriers

Cost, complexity, side effects, cognition, and beliefs require practical support. Missed doses are a clinical problem to understand, not simply a label.

## Follow the whole recipient

Graft function, proteinuria, infection surveillance, preventive care, cardiovascular risk, and quality of life remain important after the early transplant period.

## Source lessons

- [transplant immunosuppression student handout](https://urinenephrology.org/student-resources/transplant/transplant-immunosuppression-student-handout.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.