NICE has made the following recommendations about the use of immunosuppressive drugs in adults receiving kidney transplants:
Doctors should consider using 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 is a calcineurin inhibitor and 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.
Doctors should consider using mycophenolate mofetil as part of immunosuppressive treatment after kidney transplant only when a person has to stop taking a calcineurin inhibitor, or has to take a lower dose. This could be needed because the calcineurin inhibitor has already damaged the transplanted kidney. It might also be needed for a few weeks or months when there is a high risk that the calcineurin inhibitor would damage the kidney.
Sirolimus should be considered as one of a combination of immunosuppressive drugs, but only for people who cannot use calcineurin inhibitors because of their side effects.
By following these recommendations, doctors would sometimes be using medicines in ways that are not covered by their licences. NICE has reminded doctors that, when this happens, they should explain this to the person involved, and make sure he or she consents to taking the drug.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.