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Immunosuppressive drugs are used to dampen the immune response in organ transplantation.Glucocorticoids, azathioprine, cyclosporine, tacrolimus, mycophenolate, sirolimus, and various monoclonal and polyclonal antibodies all are approved for use in transplantation.Maintenance immunosuppression consists of a calcineurin inhibitor (cyclosporine or tacrolimus), glucocorticoids, and an antimetabolite (azathioprine or mycophenolate).Synergistic effects permit use of the various agents at relatively low doses, thereby limiting specific toxicities while maximizing the immunosuppressive effect.
Immunosuppressive drugs are used to dampen the immune response in organ transplantation. A multitiered approach to immunosuppressive drug therapy is employed. Several agents, each of which is directed at a different molecular target within the allograft response , are used simultaneously. Synergistic effects permit use of the various agents at relatively low doses, thereby limiting specific toxicities while maximizing the immunosuppressive effect. Therapy typically involves a calcineurin inhibitor, glucocorticoids, and mycophenolate, each directed at a discrete site in Tcell activation. Glucocorticoids, azathioprine, cyclosporine, tacrolimus, mycophenolate, sirolimus, and various monoclonal and polyclonal antibodies all are approved for use in transplantation.
Greater immunosuppression is required to gain early engraftment and/or to treat established rejection than to maintain longterm immunosuppression. Maintenance immunosuppression consists of a calcineurin inhibitor (cyclosporine or tacrolimus), glucocorticoids, and an antimetabolite (azathioprine or mycophenolate). Mycophenolate has largely replaced azathioprine as part of the standard immunosuppressive regimen after transplant.
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