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Immunosuppressive therapy, 1987
1Department of Surgery, Division of Organ Transplantation, The University of Texas Medical School at Houston, 77030, USA.
Texas Heart Institute Journal
|December 1, 1987
Summary
Cyclosporine significantly improves transplant survival but carries risks like nephrotoxicity. Monitoring cyclosporine levels and patient kidney function is crucial for safe and effective immunosuppression.
Area of Science:
- Immunology
- Pharmacology
- Nephrology
Background:
- Cyclosporine has revolutionized organ transplantation, doubling graft survival in renal transplants and improving patient survival.
- It functions by inhibiting lymphokine synthesis, notably interleukin-2, crucial for T-cell mediated immunosuppression.
Purpose of the Study:
- To review the benefits and toxicities of cyclosporine in transplantation.
- To highlight cyclosporine's nephrotoxic mechanisms and management strategies.
- To emphasize the role of pharmacokinetic profiling in optimizing cyclosporine therapy.
Main Methods:
- Literature review of cyclosporine's efficacy and adverse effects in renal and cardiac transplantation.
- Analysis of cyclosporine's impact on renal function and associated toxicities.
- Discussion of monitoring strategies and dose adjustments.
Main Results:
- Cyclosporine enhances graft and patient survival but poses risks, including hepato- and nephrotoxicity.
- Nephrotoxicity is linked to reduced renal blood flow via vasoconstriction and platelet adhesion.
- Abnormal serum creatinine and cyclosporine trough levels indicate potential toxicity or rejection.
Conclusions:
- Careful monitoring of cyclosporine levels and renal function is essential.
- Preoperative pharmacokinetic profiling can optimize cyclosporine dosing for improved outcomes.
- Managing cyclosporine toxicity may involve dose reduction and alternative immunosuppressants like azathioprine.