Solid-organ transplant patient types

The introduction of CSA signiflcantly improved the outcomes of transplantation. Since its approval and widespread use, patient and graft survival rates have improved secondary to a lower incidence of acute rejection episodes and severe infectious complications. In heart transplant recipients, for example, 1 -year survival rates increased from 56% to 85%, and 5-year survival rates increased from 31% to 15%P The efficacy of CSA is well established in aU types of solid-organ transplants. Currently, CSA is approved for use in kidney, liver, and heart transplantation. 

Clinical uses and pharmacokinetics Use of these immunosuppressants is a major factor in the success of solid organ transplantation. Cyclosporine is used in solid organ transplantation and in graft-versus-host syndrome in bone marrow transplants. Tacrolimus is used in liver and kidney transplant recipients and may be effective as rescue therapy in patients who fail standard therapy. Sirolimus is used alone or in combination with cyclosporine in kidney and heart transplantation. The agents, particularly cyclosporine, may also be effective in immune diseases, including rheumatoid arthritis, uveitis, psoriasis, asthma, and type 1 diabetes. 

After these initial approaches in animal models, ECP has been used in humans for the prevention and/or treatment of several solid organ transplant rejections, including kidney, heart, lung, pancreas, and liver. The year of introduction of ECP for treating rejection of each type of transplant is indicated in Table 5. Importantly, ECP is effective for patients resistant to conventional treatment, particularly if started early. Besides reversal of allograft rejection, a reduction in immunosuppressive therapy has also been frequently achieved [173,174]. 

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