Pharmacological immunosuppression is essential for all types of allogeneic organ transplantation (Banner and Lyster 2003). Immunosuppressive therapy is also used to treat a range of autoimmune diseases and will be essential for xenotransplantation if this becomes a clinical reality in the future (Azimzadeh et al. 2003). The efficacy of such immunosuppression depends on the mechanism of action of agents used and their capacity to specifically target those aspects of the immune response which play a key role in the alloimmune response. The discovery of cyclosporin A (hereafter ciclosporin) was a major advance in immunosuppressive therapy because of its specific effect on lymphocytes and their role in the cognate immune response while leaving the functions of the innate immune system and other aspects of the adaptive immune response intact (Borel et al. 1976). The introduction of ci-closporin into clinical transplantation was associated with improved results in the fields of kidney (The Canadian Multicentre Transplant Study Group 1986), heart (Oyer et al. 1983) and liver transplantation (Starz et al. 1981); in addition, lung transplantation became a successful procedure for the first time (Reitz et al. 1982; Toronto Lung Transplant Group 1986). Ciclosporin was also effective in the control of graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation (Deeg et al. 1985) and was found to

Table 1 Introduction of immunosuppressive agents into clinical use for organ transplantation

Approximate date


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