Pharmacologic Monitoring of Immunosuppressive Drugs

Organ transplantation as a treatment modality for patients with end-stage organ diseases of kidney, heart, liver, and pancreas has achieved impressive results in the past 2 decades thanks to better understanding of basic immunobiology and more advanced measures for medical and surgical management. Although immunosuppressive therapies to overcome host reaction to allografts have been employed since the early days of clinical transplantation, immunosuppressive agents and treatment protocols are constantly evolving. Since the 1978 introduction of cyclosporine (CsA) [1] there has been some doubt about its value as the single most important agent in the armamentarium of maintenance immunosuppression for organ transplantation. Triple-drug therapy with CsA, corticosteroid and azathioprine is now the most frequently used regimen for cadaver kidney recipients. However, the continuing search for more selective and specific agents has become, in the past decade, one of the priorities for transplant medicine. Some of these compounds are now entering routine clinical practice: among them are tacrolimus, mycophenolate mofetil (MMF) and sirolimus.