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The history of solid organ transplantation is, from an immunotherapeutic standpoint, divided in the era before and after the introduction of cyclosporine to the clinic. The introduction of cyclosporine to the clinic in 1978 is looked upon as a turning point in transplantation. The immediate success of the new drug was based on the reduction of early graft rejection and the substantial improvement of 1-year graft survival. With growing experience in the use of this new compound, together with the ability to measure drug levels in serum, allograft rejection and organ survival could be improved even further. Because of the clinical results, cyclosporine became the gold standard in immunosuppressive therapy after organ transplantation. Even after 20 years, as more and more new immunosuppressants emerge, the clinical evaluation of a new drug is frequently compared versus a cyclosporine-based regimen. Today, cyclosporine is probably one of the best investigated drugs in the field of organ transplantation. Beside the undoubted benefits of cyclosporine, experimental and clinical studies have also revealed some unwanted effects, such as nephrotoxicity and an increased risk in development of malignant tumors. Here, we review the experience at our institution with transplant recipients receiving cyclosporine as the main immunosuppressant over the past 20 years.

Renal Transplantation is hampered worldwide by the continuing lack of cadaveric organs. The discrepancy between the number of patients on the waiting list and the number of organs available is further compounded by the still unresolved problem of chronic transplant failure. Against this background, the arguments for increasing acceptance of the use of kidneys from living donors, both related and unrelated, are discussed. Initial reports on appreciably improved transplant survival rates of organs from unrelated living donors (85% survival after 3 years [19]) have since been confirmed by more recent studies. Our own results, in part obtained during a prospective study involving 103 patients (53 related, 50 unrelated) done between October 1994 and April 1999, with strict psychological care/evaluation prior to and after transplantation, revealed a four-year transplant survival rate of 98% in both groups. So far, the higher rejection rate of 34% in unrelated, vs. 13.2% in related, donors has not led to any earlier chronic dysfunction of the transplant. The expanded use of living kidney donors is not only ethically justifiable, but also improves the outcome.