Cyclosporine nephrotoxicity.
The introduction of cyclosporine (CSA) into organ transplantation was a landmark achievement leading to a substantial improvement of the early transplant results. It was particularly the reduction in early severe acute rejections that accounted for this improvement. However, on a long-term basis development of chronic transplant nephropathy did not seem to become counteracted by CSA. Conversely, CSA may cause both acute and chronic nephrotoxicity, with reduced renal transplant function along with arteriolopathy and interstitial fibrosis. This is the shortcoming of CSA as well as other calcineurin inhibitors (CNIs) such as tacrolimus (TAC). Other immunosuppressive agents were developed subsequently, including Target of Rapamycin (ToR) blockers and mycophenolate mofetil (MMF), which were not nephrotoxic. Current strategies to overcome CNI toxicity include reduction or even stopping administration of CSA or TAC along with switching to a sirolimus, everolimus or MMF based regimen. This strategy has been documented (and there are currently additional ongoing studies) to cause an improvement in renal transplant function or to reduce the deterioration rate. These measures to deal with CSA toxicity need further documentation, since a preserved good renal function seems to not only have an important impact on graft survival but also on patient survival.
Fellström
B
B
Department of Internal Medicine, Renal Unit, University Hospital, Uppsala, Sweden. Bengt.Fellstrom@medsci.uu.se
D000208:Acute Disease; D002908:Chronic Disease; D016572:Cyclosporine / Q000097:blood / Q000633:toxicity*; D016903:Drug Monitoring; D006801:Humans; D007166:Immunosuppressive Agents / Q000633:toxicity; D007668:Kidney / Q000187:drug effects / Q000473:pathology*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014181:Transplantation Immunology
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid