[Transplantation. Immunosuppression].

Abstract

Increases in the volume of organ transplantation and in the supply of new organs have been accompanied by a dramatic surge of interest in chemical immunosuppression. In the 1950s, the selection of immunosuppressive drugs was limited to azathioprine and steroids, polyclonal antilymphocyte and anti-thymocyte globulins being added in the 1960s. The 1970s witnessed a real breakthrough with the introduction of the first second-generation selective immunosuppressant, cyclosporine. During the 1980s, the focus of interest shifted to biological agents, mainly monoclonal antibodies, though only one of these, anti-CD3 (OKT3), gained wide clinical use. Finally, in the early 1990s emerged a broad range of third-generation immunosuppressants, most of them with highly specific sites of action. At least half a dozen of these are currently undergoing clinical trials.