Cyclosporin as baseline immunosuppression in solid organ transplantation

Cyclosporin is currently the basis of most immunosuppressive protocols after solid organ transplantation. In recent years a variety of new substances, such as tacrolimus, mycophenolate mofetil, sirolimus and everolimus (SDZ-RAD) have been developed. Besides these new immunosuppressants, which are structurally unrelated to cyclosporin, new formulations of cyclosporin have been introduced into the market. This review is intended to summarise the current knowledge on the use of cyclosporin as baseline immunosuppression after solid organ transplantation. Special emphasis is placed on comparison of cyclosporin-based immunosuppression with that by other recently introduced drugs that can be used as baseline immunosuppressants. Furthermore, the different formulations of cyclosporin are compared with each other. Finally, the optimal use of cyclosporin as baseline immunosuppressant in the early postoperative course as well as during long term immunosuppression is discussed from a practical perspective. During the past years a number of galenic formulations of cyclosporin with pharmacokinetic characteristics comparable to that of cyclosporin-modified-Novartis (Neoral) have been developed. Some data on oral resorption are available for the new formulations. So far, however, only healthy volunteers or patients stable after kidney or liver transplantation have been investigated in clinical trials using these new formulations. Definite data on the resorption characteristics of the new galenic formulations of cyclosporin will come from the analysis of patients with liver transplants during the early post-transplant course receiving either cyclosporin-modified-Novartis or the new cyclosporin formulations.