Issues in Cyclosporine Drug Substitution: Implications for Patient Management

Journal of Transplant Coordination, Vol. 9, Number 3, September 1999 survival rates have also improved in the past decade. Between 1986 and 1993, median cadaveric graft survival increased from 5.4 years to 8.5 years, whereas median live donor graft survival increased from 9.7 years to 14.7 years.3 Excluding death with a functioning graft, chronic rejection accounts for the majority of late graft losses.4 Risk factors for chronic rejection include history of acute rejection, inadequate immunosuppression, delayed graft function, acute tubular necrosis, donor organ characteristics (eg, age >60 years and cadaveric vs live donor), recipient characteristics (eg, gender and age), pretransplantation diseases (eg, diabetes and hypertension), and infection.5 Clinical management of the transplant recipient should therefore include strategies to prevent the development of chronic rejection, thereby improving long-term graft survival. As more options for immunotherapy become available, transplant recipients will continue to experience better short-term and long-term outcomes. The list of available immmunosuppressants continues to expand (Table 1) and several other promising new agents are under investigation. Although new combinations are being tested, the current optimal immunosuppressive regimen remains predominantly calcineurin-inhibitor based. Issues in cyclosporine drug substitution: implications for patient management