Section Review: Pulmonary-Allergy, Dermatological, Gastrointestinal & Arthritis: New modes of immunosuppression for the prevention of allograft rejection

Abstract

Transplanted allografts are susceptible to immune mediated rejection, and this will occur within days without induction of immunological tolerance. Until recently, the standard ‘triple’ regimen for immunosuppression has been cyclosporin in combination with azathioprine and corticosteroids. The addition of Tacrolimus to primary immunosuppressive drug regimens has occurred at a time when other drugs, also inhibiting T-cell proliferation, are undergoing clinical trials. Inhibition of T- and B-cell proliferation has the potential for wide ranging toxic effects on other organs of the body. Future use of these drugs is likely to use lower doses, supplemented by specific monoclonal antibody therapy to manipulate diverse arms of the immune response. The purpose of this review is to discuss the pathophysiology of allograft rejection and to review data regarding newer immunosuppressive drugs, outlining their advantages and disadvantages compared with cyclosporin.

Key Words:

• allograft rejection
• tacrolimus
• rapamycin
• deoxyspergualin
• brequinar
• mycophenolate mofetil
• leflunomide
• SK&F 105685
• monoclonal antibodies in solid organ transplantation
• HLA therapy
• immunosuppression