DAVID J. COHEN, M.D.; ROLF LOERTSCHER, M.D.; MARIO F. RUBIN, M.D.; NICHOLAS L. TILNEY, M.D.; CHARLES B. CARPENTER, M.D.; TERRY B. STROM, M.D.
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.
COHEN DJ, LOERTSCHER R, RUBIN MF, et al. Cyclosporine: A New Immunosuppressive Agent for Organ Transplantation. Ann Intern Med. 1984;101:667–682. doi: 10.7326/0003-4819-101-5-667
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Published: Ann Intern Med. 1984;101(5):667-682.
Cardiology, Emergency Medicine, Gastroenterology/Hepatology, Hematology/Oncology, Leukemia/Lymphoma.
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