Curtis J J
University of Alabama at Birmingham, Division of Nephrology, Birmingham, AL 35294-0006, USA.
Transplant Proc. 2004 Mar;36(2 Suppl):54S-58S. doi: 10.1016/j.transproceed.2003.12.044.
Cyclosporine ended the azathioprine-prednisone era of transplantation. For years prior to cyclosporine, regimens in transplant centers were relatively fixed and all patients received the same two drugs in nearly the same doses with adjustments made primarily for toxicities. Transplant physicians became expert in the side effects of steroids and azathioprine. Cyclosporine changed everything. Change is never easy, however, and initial resistance to changing protocols (especially for a new nephrotoxic drug) was only overcome by randomized, controlled trials. Cyclosporine increased allograft and patient survival rates without increasing opportunistic infections. However, as important were the changes in thinking that came about. It can be argued that cyclosporine contributed to expanding multicenter controlled trials in the transplant community. It also helped bring about concepts such as tailoring drugs to individual patients, drug minimization or elimination, use of polypharmacy, and focus on the first few weeks after transplant. Understanding of T-cell function and causes of renal dysfunction were brought into clearer focus by this exciting new agent.
环孢素结束了移植领域中硫唑嘌呤 - 泼尼松的时代。在环孢素出现之前的数年里，移植中心的治疗方案相对固定，所有患者都接受几乎相同剂量的两种药物，并主要根据毒性进行调整。移植医生对类固醇和硫唑嘌呤的副作用了如指掌。环孢素改变了一切。然而，改变绝非易事，对改变方案（尤其是针对一种新的肾毒性药物）的最初抵触情绪，直到随机对照试验出现才得以克服。环孢素提高了同种异体移植物和患者的存活率，同时并未增加机会性感染的发生率。然而，同样重要的是随之而来的思维转变。可以说，环孢素推动了移植领域多中心对照试验的扩展。它还促使了一些理念的形成，比如为个体患者量身定制药物、药物最小化或消除、联合用药的使用，以及关注移植后的头几周。这种令人兴奋的新药使人们对T细胞功能和肾功能障碍的病因有了更清晰的认识。
