Abstract:

Since active clinical transplantation became a reality, physicians have been in constant conflict with the body's immunologic defenses. Steroids and azathioprine were the mainstay of immunosuppressive therapy for many years. During these years, graft survival was modest, with survival rates of 50% or less at one year for cadaver transplants. After the introduction of cyclospor ine A in 1983, renal cadaver graft survival rates increased to 60-75%. Since that time, other immunosuppressive agents such as OKT3 and better patient management have increased 1-year graft survival rates well above 80%. Nevertheless, present immunosuppressive regimens remain toxic, nonspecific, and render the patient at increased risk of infection and lymphoproliferative disorders. Presently there exists no "magic bullet" that can render the immune system incapable of rejecting a graft while allowing the patient continued defense against infection. However, a new drug, mycophenolate mofetil (MMF; CellCept®;RS-61443)comes surprisingly close to this concept by emphasizing a unique mechanism of action.

Authors:

Carlton J. Young, M.D., University of Arizona School of Medicine, Tucson, AZ; Hans W. Sollinger, M.D., Ph.D., University of Wisconsin School of Medicine, Madison, WI

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