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A Comprehensive Review of Calcineurin Inhibitors Used for Immunosuppression in Cardiac Transplantation

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Pharmacology of Immunosuppression

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 272))

Abstract

Calcineurin inhibitors (CNIs) have been the foundation of immunosuppression in solid organ transplantation since the 1980s. Cyclosporine A (CSA), the first in class, was identified as the metabolite of the soil fungus Tolypocladium inflatum Gams as part of a larger program of screening for naturally occurring fungal metabolites with biologic activity in the 1970s. Significant immunosuppressive effects were discovered and consequently CSA was trialed as an immunosuppressant in renal transplantation. This initial success led to its widespread study and adoption in solid organ transplantation. This novel agent yielded significant improvements in both 1 year and longer-term allograft and patient survival. Subsequently, a similar and more potent CNI, tacrolimus was developed. Today, it is the principal CNI used for prevention of allograft rejection. Like all other immunosuppressives, the benefits of CNIs are counterbalanced by side effects and complications resulting from drug toxicity. This chapter comprehensively reviews the clinical use of CNIs in cardiac transplantation.

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Author information

Authors and Affiliations

  1. Audie Murphy VA Medical Center, San Antonio, TX, USA

    Lydia R. Engwenyu

  2. Division of Cardiology, Department of Medicine, Joe R. and Teresa Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA

    Lydia R. Engwenyu & Allen S. Anderson

Authors
  1. Lydia R. Engwenyu
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  2. Allen S. Anderson
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Corresponding authors

Correspondence to Lydia R. Engwenyu or Allen S. Anderson .

Editor information

Editors and Affiliations

  1. Heart and Vascular Institute, Pennsylvania State University, Hershey, PA, USA

    Howard J. Eisen

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© 2021 This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply

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Engwenyu, L.R., Anderson, A.S. (2021). A Comprehensive Review of Calcineurin Inhibitors Used for Immunosuppression in Cardiac Transplantation. In: Eisen, H.J. (eds) Pharmacology of Immunosuppression. Handbook of Experimental Pharmacology, vol 272. Springer, Cham. https://doi.org/10.1007/164_2021_549

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