Vs. Gorantla et al., Immunosuppressive agents in transplantation: Mechanisms of action and current anti-rejection strategies, MICROSURG, 20(8), 2000, pp. 420-429
Over the past century, the concept of interfering with the immune response
at various sites by blocking the formation, stimulation, proliferation, and
differentiation of lymphocytes has led to relentless development of new im
munosuppressive drugs. These agents are associated with reduced risk of sho
rt- and long-term toxicity and have dramatically improved allograft and pat
ient survival, especially in recipients of solid organ transplants. Current
protocols in such patients are nearly all calcineurin-inhibitor based, usi
ng cyclosporine or tacrolimus, as part of dual, triple, or sequential thera
py. This review focuses on agents currently in clinical use at transplant c
enters in United States. The drugs are described in terms of their basic me
chanisms of action, therapeutic uses, clinical studies, and adverse effects
. In addition. the efficacy and toxicity of a few promising new therapeutic
approaches are examined. Finally, important challenges regarding pharmacol
ogical immunosuppression as it relates to solid organ and composite tissue
allotransplantation are discussed, (C) 2000 Wiley-Liss, Inc.