Introduction, global perspectives and history of immunosuppression

Abstract

For the first 20 years of clinical organ grafting, from the mid-1960s to the mid-1980s, azathioprine and corticosteroids were the lynchpins of immunosuppression. There were some preparations of polyclonal antilymphocyte sera that had proven efficacy although batch variation was a worry to clinicians. Following the introduction of cyclosporine A (CsA) in the early 1980s the results of organ transplantation improved to such a degree that this drug served as a watershed, changing transplantation from a speculative, dangerous and often unsuccessful enterprise, into a form of therapy that was widely used. Clinical transplantation units were established world-wide for transplanting not only kidneys but also hearts, liver, lung, pancreas and multiple organ transplants. Recently this spectrum has been further extended by the early success in transplantation of the hand. The results achieved with CsA stimulated the development of new potent immunosuppressive agents broadly divided into drugs, all of which have side-effects, and biologicals like antibodies.