Clinical use of immunosuppressants in transplantation

Summary

The challenge of clinical immunosuppression is to reduce destructive immune activity without incurring the complications of immunodeficiency, namely infections and malignancy. Existing agents such as cyclosporine, azathioprine and corticosteroids leave about one half of all patients with rejection episodes, which can adversely affect short- and long-term outcomes. In addition, the current agents have considerable non-immune toxicity, such as the nephrotoxicity of cyclosporine. Newer agents with improved therapeutic indices are in various stages of development, including some which have been designed on the basis of recent progress in understanding immune mechanisms. It is likely that clinical immunosuppression will be more effective but also more complex, as the new agents are released and many new combinations of agents are used. In this chapter we provide an overview of the mechanisms of transplant rejection and how various immunosuppressive approaches can interrupt this process. The simultaneous emergence of new basic understanding of immune processes and new specific interventions should lead to immunosuppressive strategies based on principles, rather than empiricism.

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Broski, A.P., Halloran, P.F. Clinical use of immunosuppressants in transplantation. Perspectives in Drug Discovery and Design 2, 3–24 (1994). https://doi.org/10.1007/BF02171733

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Key words

  • Immunosuppression
  • Transplantation
  • Rejection