The National Institute for Clinical Excellence (NICE) has issued guidance to the NHS in England and Wales on the use of immunosuppressive therapy for renal (kidney) transplantation in adults. The guidance recommends:

• Basiliximab or daclizumab for induction treatment (immediately after the kidney transplant). These drugs should be used with a combination of other drugs including a calcineurin inhibitor such as ciclosporin. The cheapest one of the two (basiliximab or daclizumab) should be used.

• Tacrolimus (a calcineurin inhibitor) can be used instead of ciclosporin when a person needs a calcineurin inhibitor as part of their initial or maintenance immunosuppressive treatment after a kidney transplant. The drug (tacrolimus or ciclosporin) that is least likely to have serious side effects in that particular person should be used.

• Mycophenolate mofetil is recommended for adults as an option as part of an immunosuppressive regimen only:

- where there is proven intolerance to calcineurin inhibitors, such as nephrotoxicity leading to risk of chronic allograft dysfunction, or

- in situations where there is a very high risk of nephrotoxicity necessitating minimisation or avoidance of a calcineurin inhibitor

• Sirolimus as one of a combination of immunosuppressive drugs, but only for people who cannot use calcineurin inhibitors because of their side effects.

Additionally, the guidance state that these recommendations contain advice that may result in some medicines being prescribed outside the terms of their marketing authorisation. Clinicians prescribing these drugs should ensure that patients are aware of this, and that they consent to their use in such circumstances.