**Abstract**

Renal transplantation is the treatment modality of choice in end stage renal disease. However, in low economic countries where government or insurance funding is not available, several patients do not opt for this treatment due to financial constraints. However, there could be options of tailored immunosuppression in both initial intensive induction immunosuppression and subsequent maintenance immunosuppression and immunomodulation thereby making this modality of treatment more cost effective. This could include selective use of induction agents, lesser frequency and dosing, use of cheaper induction agents and their combination, monitoring to decide the minimal dosage and frequency required and cost effective maintenance immunosuppressive agents with dose adjustment based on blood levels.

**Keywords:** cost effective immunosuppression, induction immunosuppression, maintenance immunosuppression, rituximab, renal transplantation
