ABSTRACT
Solid organ and bone marrow transplantation have been revolutionized by the availability of immunosuppressive agents developed over the past few decades. The first and most widely used is cyclosporin A (CsA), a fungal metabolite with immunosuppressive properties first described by Borel in 1972. The drug acts on the immune system to selectively inhibit T-cell activation and interleukin-2-mediated events. Tacrolimus (FK506), a more recently discovered macrolide fungal product, also inhibits T-cell activation. Both of these agents, which act via inhibition of calcineurin, can produce acute and chronic renal toxicity, and therapeutic and toxic levels may be tightly linked. Additionally, antibody-based therapies are being more widely used in immunosuppressive protocols to destroy effector T-cells or block receptors and prevent or treat cell-mediated or antibody-mediated acute rejection. These agents also may have effects on renal function.
