[Side effects and toxicity of immunosuppressive agents]

The toxicity and side effects of immunosuppressive drugs currently used in the clinical practice of renal transplantation are examined. Different immunosuppressive drugs act during different points of T-cell maturation, thus allowing the concomitant association of different drugs to reduce clinical toxicity. Immunosuppressive drugs have two kinds of toxicity: "therapeutic toxicity" and "nontherapeutic toxicity". Only the latter is the topic of this review. A similar toxicity profile is shared by various immunosuppressive drugs. In planning treatments, drugs must be chosen based on their toxicity profile and their adequate effect on the clinical syndrome being treated. The main calcineurine inhibitors (CNI) side effects are nephrotoxicity, cardiotoxicity, and post transplant diabetes mellitus (PTDM). Steroids have multiple side effects, the most important of which are negative effects on bone and cardiovascular function. New drug trials have been undertaken to find immunosuppressive drugs with lower toxicity and less negative impact on bone and cardiovascular function. In preliminary studies, Sirolimus seems to have a less severe side effects profile.