Pharmacologic immunosuppression: cure or curse?

With the advent of cyclosporine in the 1980s, transplantation has become the treatment of choice for many endstage organ diseases. However, there is a price to pay. Pharmacologic immunosuppression has numerous side effects, some of them serious. This article discusses traditional (corticosteroids and azathioprine), current (cyclosporine and antilymphocyte preparations), and future (FK 506, rapamycin, mycophenolate mofetil [RS-61443], brequinar, deoxyspergualin, and new monoclonal antibodies) immunosuppressive agents. How these drugs are used and their side effects are examined. Has a cure been provided? No; patients must continue medical care regularly and take medications daily. Is this a curse? If so, it is one most recipients would choose again. Perhaps both a cure and curse have been provided. Transplantation will become less of a curse and more of a cure as improvements in immunosuppression occur.