Evolution of immunosuppression in liver transplantation: contribution of cyclosporine.
Liver transplantation has become the standard therapy for patients with end-stage liver disease or acute liver failure, with excellent outcomes in terms of quality of life and length of survival. The use of immunosuppressive agents, without any doubt, has played a crucial role in the establishment of this technique and improved short- and long-term survival rates. Eventually, mortality from acute or chronic rejection may be entirely eliminated. Minimizing the adverse effects of immunosuppressive agents is essential to improve long-term survival and quality of life. In this chapter, we review the history of immunosuppressive agents for liver transplantation with consideration of the pre- and the postcyclosporine eras. We also review the development and contributions of cyclosporine, the excellent outcomes from C2 monitoring, comparisons between the cyclosporine microemulsion and the oil-based formula, as well as between cyclosporine microemulsion versus tacrolimus. In addition, details are provided on the newer immunosuppressive agents: mycophenolate mofetil, sirolimus, and the IL-2 receptor antagonists, as well as agents in development: CAMPATH 1-H, thymoglobulin, everolimus, FT720, and FK778.
Furukawa
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Department of Organ Transplantation and Regenerative Medicine, Hokkaido University School of Medicine, Sapporo, Japan. f-hiro@med.hokudai.ac.jp
Todo
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D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D007165:Immunosuppression Therapy / Q000639:trends*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality / Q000639:trends; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D016019:Survival Analysis; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus