[Cyclosporin in heart transplantations. The authors' personal experience].
The discovery of cyclosporine A (CsA) was a major development in the evolution of organ transplantation. In renal transplantation use of CsA improved graft survival such that HLA-matching is no longer as important and determinant as before. Liver transplantation prior to the arrival of CsA was almost abandoned by Starzl because of uncontrollable rejection. Hearth transplantation, after initial enthusiasm, was soon restricted to few centers as the difficulties in caring for these patients became apparent. Availability of CsA allowed more than 2500 hearth transplants to be performed annually today. At Stanford initially cardiac transplant survival at one year was 40% and at 5 years was approx 20%. The best results in patients treated with azathioprine-prednisone, just prior to the introduction of cyclosporine, were 65% and 40%. At present survival is 83% at 1 year and 50% at 6-7 years, as in other active centers around the world. CsA is the first drug specifically developed to target immunocompetent T-lymphocytes, and is the gold standard model for other new drugs. Its action is modification of rejection, so that when it occurs it is less acute in onset and less fulminant. The prevalence and mortality of infections have also been reduced. The major drawback of cyclosporine is nephrotoxicity: all patients undergo a progressive decline in creatinine clearance and within one year 90% have hypertension. A second problem is post-transplant lymphoproliferative disease, that takes the form of an aggressive and potentially lethal B-cell lymphoma appearing most commonly within one year from surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Perlroth
M G
MG
Falk Cardiovascular Research Center, Stanford University School of Medicine.
Delfino
M
M
D016572:Cyclosporine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy
D016572:Cyclosporine
La ciclosporina nei trapianti di cuore. Esperienza personale.