Passed by the NKF 11th July 2015, updated April 2020

The NKF supports the NHS in initiating and maintaining immunosuppression with the most clinical and cost effective regimen tailored to the needs of an individual patient.

The NKF supports the use of generic immunosuppression where there are no safety concerns, but critical-dose drugs like ciclosporin and tacrolimus should be treated with caution.

All prescribing of critical-dose immunosuppressant drugs must be by brand name to avoid any unwanted error.

Any change in prescription of critical-dose immunosuppressant drugs must be by kidney specialists at the transplant centre.

Such changes must be closely monitored to avoid unwanted fluctuations in kidney function and drug base level.

Multiple or frequent changes of supplier of critical-dose immunosuppressant drugs must be avoided as they can confuse transplant recipients and may lead to adverse outcomes such as acute rejection or nephrotoxicity. 

The NKF recognises there are sub-groups of transplant patients who may benefit from drug that are more expensive in the short-term but which may be more cost-effective in the long term by maximising transplant (graft) survival.