Sivathasan C
Department of Cardiothoracic Surgery, National Heart Centre, Heart/Lung Transplant, Singapore.
Transplant Proc. 2004 Mar;36(2 Suppl):346S-348S. doi: 10.1016/j.transproceed.2004.01.072.
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.
20世纪80年代初环孢素作为一种免疫抑制剂的引入极大地改善了器官移植的结果。在该十年的早期，高剂量环孢素的肾毒性和淋巴瘤发病率增加等不良反应被认识到。这导致了环孢素剂量的降低，并与泼尼松龙和硫唑嘌呤联合使用，作为移植免疫抑制的基础。在20世纪90年代后半期，引入了环孢素的微乳剂配方，其药物吸收情况更佳且可预测。治疗药物监测被视为优化移植结果并使副作用最小化的一种工具。与长期环孢素治疗相关的肾毒性已被认识到；我们正在学习采取措施将其最小化。随着我们进入使用环孢素的第三个十年，以环孢素为基础的免疫抑制方案仍然是心脏移植中最常用的方法。正在探索将新型药物与作为核心免疫抑制剂的环孢素联合使用。
