Cyclosporine Therapy for Kidney Transplant: What is New for an Old-Fashioned Therapy?

Abstract

Calcineurin inhibitors have been the mainstay of immunosuppression for the last decades and nowadays still remain as relevant drugs in the setting of solid organ transplantation. Nevertheless, the balance between excess of immunosuppression with cyclosporine (leading to increased risk of metabolic complications, nephrotoxicity or cancer), or its insufficiency (with augmented risk of rejection), is even so a challenge in the clinical practice. The aim of this paper is to review the pharmacokinetic and pharmacodynamic evolution of this landmark drug. We also discuss what could we expect on this CNI drug in this decade.

Preimplantation Biopsy Predicts Delayed Graft Function, Glomerular Filtration Rate and Long-Term Graft Survival of Transplanted Kidneys

“…Nowadays, biopsies can be considered a graft survival prediction tool, with high specificity (despite a low sensitivity). Since the cyclosporine era of immunosuppression, we have dramatically reduced the impact of allograft acute rejections, remaining with late losses due to chronic allograft dysfunction (25). This has become the most important problem in solid organ transplants, mediated by a myriad of etiopathological mechanisms and without specific treatment (22,23).…”

Cyclosporin A: A Repurposable Drug in the Treatment of COVID-19?

“…CsA is metabolized by liver cells through the P450 3A4 (CYP3A4) leading to the generation of a number of metabolites ( 46 ). After a single dose of CsA, there is a peak of drug blood concentrations (Cmax) during the first 2 h followed by elimination (C0), and the drug bioavailability should be carefully monitored in clinical settings using the Cmax and a measure of drug concentration every 2 h (C0, C2, C4, C6, C8) to determine when an additional dose should be administered ( 47 ).…”