Learning and new discovery with cyclosporine in the cambridge-king's programme: a personal view

Abstract 

Immunosuppressive regimens in the early precyclosporine days of liver transplantation for the Cambridge-King's Programme from 1968 until the early 1980s were inadequate in the control of rejection. The consequent use of high-dose steroids led to many infections, which seriously affected outcome. Nevertheless, occasional patients did well but a consistent increase in survival was not seen until after the introduction of cyclosporine and experience was gained with its proper usage in terms of toxicity. The development of Neoral with its greater oral bioavailability marked a major step forward in the development of the drug. Whether 2-hour postdose monitoring with reduction in rejection frequency and toxicity as described recently better match results with tacrolimus in comparison-controlled trials remains to be determined.