FIG. 4. The use of cyclosporine and steroids.

Note that the cyclosporine initially is given intravenously (IV) and that the IV therapy is continued long after the drug is begun orally. The switch from double-route cyclosporine therapy to the oral route alone is carefully monitored with cyclosporine blood levels. Note the seeming increase in enteral absorption after clamping of the T-tube, the insistence on maintaining high blood levels of cyclosporine despite obvious low-grade nephrotoxocity, and the intensification of steroid therapy with either a cycle or intermittent bolus administration with suspicion of rejection. Large arrows: methylprednisolone sodium succinate; small arrows: hydrocortisone sodium succinate. (Reproduced with permission from Starzl et al.⁴²)