Cardiac transplantation: the changing faces of immunosuppression

Many advances have been made in immunosuppressive therapy and other aspects of cardiac transplant management since the first cardiac transplantation was performed in the late 1960s. The cellular immune response and rejection process are better understood. This knowledge changed the way existing drugs were used to control rejection and led to the development of new drugs that could more effectively control the rejection process. Early drug protocols used combinations of azathioprine, antilymphocyte globulin, and steroids. Later protocols used combinations of cyclosporine, steroids, and antithymocyte globulin. After problems related to cyclosporine were identified, protocols came full circle. They now include drugs that were used in earlier protocols, as well as cyclosporine. The purpose of this article is to describe how protocols for immunosuppressive therapy have evolved based on our expanded knowledge of immunosuppression and methods of best using new and old drugs to achieve this goal.