Organ allotransplantation since the advent of cyclosporin

Successful long-term organ transplantation has been made possible by the use of conventional immunosuppression. In contrast with transplantation of other organs, transplantation of the kidney has become an accepted successful form of therapy, 80% of patients being fully rehabilitated. However, complications of therapy are frequent and severe and include bone necrosis, cataract formation, infections and stunted growth in children. The discovery of the immunosuppressive properties of cyclosporin A (CYA) by Borel in 1976 offered new hope to recipients of hepatic, cardiac, pancreatic and heart-lung transplants, since rejection frequently resulted in death. Although the use of CYA has led to significant accomplishments, subsequent studies have documented deleterious side-effects including nephrotoxicity, hepatotoxicity, hirsutism, gingival hyperplasia, tremors and tumours. Yet despite the side-effects, CYA has proved to be a promising immunosuppressive agent for use in human organ transplantation and is at present being evaluated in transplant centres throughout the world.