Table 2.
Maintenance immunosuppression drugs
| Drug | Mechanism of action | Side effects |
|---|---|---|
| Corticosteroids | Blocks transcription of cytokine genes, IL-1, IL-2, IL-3, IL-5, IL-6, tumor necrosis factor-α, and interferons | Hypertension |
| Glucose intolerance | ||
| Dyslipidemia | ||
| Osteoporosis | ||
| Cyclosporin | Inhibits IL-2 production, stimulates TGF-β production | Nephrotoxicity |
| Hypertension | ||
| Dyslipidemia | ||
| Glucose intolerance | ||
| Tacrolimus | Inhibits IL-2 production | Nephrotoxicity |
| Hypertension | ||
| Dyslipidemia | ||
| Glucose intolerance | ||
| Azathioprine | Inhibits purine synthesis and blocks DNA and RNA synthesis Inhibits CD28 signaling |
Myelosuppression |
| Mycohphenolate mofetil | Blocks de novo pathway of purine synthesis (selective for lymphocytes) and blocks glycosylation | Diarrhea and gastrointestinal upset Myelosuppression |
| Sirolimus/everolimus | Blocks IL-2-induced cell cycle progression | Hyperlipidemia |
| Thrombocytopenia | ||
| Impaired wound healing | ||
| Oral ulcers | ||
| Belatacept | Blocks costimulation by CD28 | PTLD in EBV naïve patients |
Abbreviations: EBV, Epstein–Barr virus; IL, interleukin; PTLD, posttransplant lymphoproliferative disorder; TGF, transforming growth factor.