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Toxicity 7.1

General Effect of Immunosuppression

Pharmacological immunosuppression is not specific for the response to the transplanted organ or the disease under treatment. Therefore patients receiving immunosuppressive treatment are at increased risk of infection and of certain types of malignancy (Fishman and Rubin 1998; Penn 2000; Eu-vrard et al. 2003). Calcineurin-inhibitors principally affect the adaptive immune response of T cells and leave the innate immune system intact. Therefore conditions such as chronic viral infection that are particularly controlled by T cell responses would be expected to be increased in patients receiving CNIs (Cohen 2000; Banner 2003). However, because CNIs are used in combination with other immunosuppressive agents, their selective effect on the immune system is lost and a wide spectrum of infections may be encountered (Kahan 1989; Fishman and Rubin 1998).

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