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Cyclosporine: A New Immunosuppressive Agent for Organ Transplantation

DAVID J. COHEN, M.D.; ROLF LOERTSCHER, M.D.; MARIO F. RUBIN, M.D.; NICHOLAS L. TILNEY, M.D.; CHARLES B. CARPENTER, M.D.; and TERRY B. STROM, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to David J. Cohen, M.D.; Department of Medicine, Renal Division, Columbia-Presbyterian Medical Center, 622 W. 168th Street; New York, NY 10032.


Boston, Massachusetts


©1984 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1984;101(5):667-682. doi:10.7326/0003-4819-101-5-667
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Cyclosporine, a cyclic endecapeptide of fungal origin, has recently been released for use in clinical transplantation. Trials in kidney, heart, liver and bone marrow recipients were encouraging: 1-year graft survival rates were 70% to 80% for kidney and heart recipients, and 60% to 65% for liver allograft recipients. Cyclosporine is also effective in treating bone marrow recipients with acute graft-versus-host disease. The drug selectively inhibits T-helper cell production of growth factors essential for B cell and cytotoxic T-cell differentiation and proliferation, while allowing expansion of suppressor T-cell populations. Drug absorption varies greatly, necessitating monitoring of drug level and individualization of therapy. Nephrotoxicity is the most frequent side effect of cyclosporine. An increased incidence of B-cell lymphomas seen when cyclosporine was used in conjunction with cytotoxic agents or anti-lymphocyte globulin has very rarely been observed when concomitant immunosuppression has been limited to low-dose corticosteroids. Lower initial doses of cyclosporine followed by more rapid tapering may reduce the incidence of nephrotoxicity without compromising improved graft outcome.

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