title: Cyclosporine monotherapy in cardiac transplantation: review of the literature.
abstract: The immunosuppressive therapy after organ transplantation should be tailored to balance the tolerance and the reaction of the recipient against the graft to avoid lack of immunosuppression or an excess of drugs. The drugs currently used may induce serious side effects with negative impact on recipient's survival and quality of life even if lack of immunosuppression may induce acute graft rejection and patient's death. The introduction of new drugs as mammalian target of rapamycin (mTOR) inhibitors allows tailoring of the immunosuppressive therapy on patient characteristics, by the use of drug association and the reduction of the overall dose. There are few cases where the necessity of reduction of the immunosuppressive therapy should be considered, as what happens in cases of severe systemic infections. Some anecdotal reports of the use of cyclosporine monotherapy (CM) in heart transplantation have been presented many years ago: the main limitations of these reports were the reasons of the switch to CM and the limited number of patients that did not allow clarification of the indications and the applicability of the CM. The aim of our review is to offer an up-to-date research of the use of CM after heart transplantation for physicians enrolled in the management of such complicated patients. The discussion will start from the kidney and liver transplantation and will arrive to the heart transplantation. However, we suggest a very careful selection of patients to be treated with CM because the use must be restricted to cases of severe side effects caused by multiple therapies because the multiple approaches has the main advantage of the synergistic action of the drugs. In conclusion, CM must be use for selected low-immunologic-risk patients, and it could be carefully used for stable patients over the long-term follow-up when the risk of acute rejection has nearly disappeared. Our article is of historical interest since we do not use anymore cyclosporine monotherapy.
authors.affiliation: Division of Cardiac Surgery, San Giovanni Battista Hospital, University of Turin, Corso Bramante 88, 10135, Turin, Italy. fabrisans@katamail.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sansone
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
mesh_terms: D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation; D016031:Liver Transplantation; D018579:Patient Selection; D011788:Quality of Life; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D058570:TOR Serine-Threonine Kinases