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Zaključak

Od momenta kada je prvi put primenjen, kasnih sedamdesetih i početkom osamdesetih godina
prošlog veka, CsA je nesumnjivo napravio revoluciju u transplantacionoj medicini smanjenjem
učestalosti akutnih odbacivanja i poboljšanjem jednogodišnjeg preživljavanja transplantiranog
bubrega. Uprkos akutnoj nefrotoksičnosti koja je dozno zavisna i koja se sve ređe susreće od kako
se daju male doze CsA, kao i činjenici da se sve više sumnja u postojanje hronične nefrotoksičnosti

CsA, ovaj lek i dalje ostaje osnov terapijskih protokola nakon transplantacije solidnih organa.
Neimunološki neželjeni efekti kalcineurinskih inhibitora obavezuju dodatna istraživanja u cilju
pronalaženja optimalnih imunosupresivnih protokola koji će obezbediti minimalne neželjene efekte
uz održavanje niskog rizika za nastanak akutnog odbacivanja.

Abstract

Cyclosporine (CsA) was discovered in the lab of Sandoz in Switzerland in 1972. while searching for an antifungal drug.
However, it quickly became an irreplaceable immunosuppressive drug for renal and other solid organ transplantation. It
has been found, in the initial experiments, that CsA inhibits both in vitro cell-mediated lysis and lymphocyte sensitization
by allogeneic target cells. Clinical trials have demonstrated better one-year graft survival after cadaveric renal transplants
when receiving CsA instead of azathioprine. Although improvement has been observed in the rates of one-year renal graft
survival and acute rejection, but long-term graft survival rate did not improve. This can be attributed to the nephrotoxic
effects of the CsA. This issue is a consequence of hemodynamic effects on renal blood flow and glomerular filtration,
effect on renal tubular function and blood vessels. Along with nephrotoxicity, CsA also causes other adverse effects such
as hypertension, gingival hyperplasia, hyperkalemia, hypomagnesemia, hyperlipidemia, neurotoxicity, and in some cases
thrombotic microangiopathies. However, in recent years CsA nephrotoxicity has been looked at from a different angle,
where it has been linked to high CsA doses that used to be administered. Following its use in solid organ transplantation,
CsA has been found to have an important role in treating systemic connective tissue diseases, as well as its consequences,
primary glomerulonephritis, inflammatory bowel disease, and psoriasis. CsA effectiveness in treating above mentioned
diseases is still greater than its side effects, which makes it a base of treatment options for numerous diseases.

Keywords: cyclosporine, transplantation, nephrotoxicity, glomerulonephritis, psoriasis, inflammatory bowel disease

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