Solid-organ transplantation acute rejection

Successful outcomes in solid-organ transplantation generally are measured in terms of several separate end points (1) preventing acute rejection (2) increasing 1-year graft survival ... 

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. 

TABLE 5 Use of Extracorporeal Photopheresis for Prevention or Treatment of Acute Rejection Episodes after Solid Organ Transplantations ... 

In 1989 tacrolimus (FK 506), a second caldneurin inhibitor started its clinical journey [8]. Tacrolimus has an immunosuppressive effect approximately 100 times more potent than CsA and early clinical trials demonstrate that FK 506 was effective in reversing refractory acute rejection in renal, liver and heart transplantation. Subsequently, this drug showed to be at least as effective as CsA in the primary immunosuppression schedules for solid organ and bone marrow transplantation and, similarly to CsA, proved to be a valuable alternative in the treatment of autoimmune diseases [3,9-11]. At the moment, FK 506 is considered the only drug that can substitute CsA in primary immunosuppression schedules and it is currently used in almost 60% of liver transplantation immunosuppressive prescriptions. 

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