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Table 3 Evolving low-toxicity maintenance immunosuppression regimens

From: New immunosuppressive drugs in heart transplantation

Regimen Comment
Cyclosporine + azathioprine/MMF + steroids Standard regimen. MMF preferred because it reduces incidence of acute rejection; significantly more expensive. Neoral replacing. Sandimmune in many centers.
Tacrolimus + azathioprine + steroids Alternative regimen to above
Daclizumab/basiliximab + MMF + steroids IL-2 receptor blockers used only in early post-transplant period but may obviate need for calcineurin inhibitor.
Tacrolimus + MMF + steroids Preliminary studies suggest very low incidence of acute rejection; gastrointestinal side effects are common but minimal steroid should reduce risk of diabetes mellitus.
Sirolimus + cyclosporine + steroids Sirolimus may allow greater reduction in cyclosporin or steroid doses.
  1. IL, interleukin; MMF, mycophenolate mofetil.
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