Experience with cyclosporine in heart transplantation.

The introduction of cyclosporine as an immunosuppressant in early 1980s dramatically improved the outcome of organ transplantation. The adverse effects of nephrotoxicity and increased incidence of lymphomas were recognized with high doses of cyclosporine during the early part of that decade. This led to lower doses of cyclosporine and combination with prednisolone and azathioprine as the basis of immunosuppression in transplantation. During the second half of the 1990s, the microemulsion formulation of cyclosporine was introduced that gave superior and predictable drug absorption profiles. Therapeutic drug monitoring is considered as a tool to optimize transplantation results and minimize side effects. The nephrotoxicity associated with long-term cyclosporine therapy is recognized; we are learning to take measures to minimize it. As we enter the third decade of cyclosporine use, cyclosporine-based immunosuppressive protocols remain the most popular method in heart transplantation. Newer agents in combination with cyclosporine as the core immunosuppressant are being explored.