Cyclosporine: progress, problems, and perspectives

Since it much heralded debut, cyclosporine appears to have gained a major role in organ transplantation. The drug appears to have gained widespread acceptance as the immunosuppressive treatment of choice for high-risk cadaveric renal transplant recipients as well as for extrarenal organ graft recipients who depend upon a successful allograft for survival. Most centers have utilized either HPLC or RIA assays for cyclosporine levels in blood or serum to maximize immunosuppressive therapy with minimal toxicity during the critical period of induction therapy. In most patients, the balance between therapeutic and toxic effects of cyclosporine favors the immunosuppressive efficacy of the drug. Long-term consequences of cyclosporine therapy and innovative future treatment protocols will define the size of the role cyclosporine will play in the future as well as the interaction with uncast groups, such as highly presensitized patients.