The shortage of available organs in relation to the potential recipient pool remains the major factor limiting progress in transplantation. Efforts to maximize the efficacy of organ transplantation have focused on both improving immunosuppressive therapy and identifying those factors in both donor and recipient that adversely affect graft survival.
Cyclosporine, the mainstay of immunosuppressive therapy in transplantation, has improved graft survival of all organs. Multicenter studies have not substantiated concerns regarding the nephrotoxic effects of cyclosporine; in a cohort of 1663 renal transplant recipients, a median increase in the serum creatinine level of 0.0884 μmol/L (0.001 mg/dL) per month occurred during a 3-year period, and the serum creatinine level was inversely correlated with cyclosporine dose.1
Tacrolimus (FK 506), a macrolide with a mechanism of action similar to that of cyclosporine, has been widely studied in clinical trials and was approved for liver transplantation in April 1994. The US Multicenter
Hardy MA, Sung RS. Transplantation. JAMA. 1995;273(21):1723-1725. doi:10.1001/jama.1995.03520450093049