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Mycophenolate

De novo purine synthesis in lymphocytes

Gastrointestinal

++++

Cyclosporine

IL2 inhibition in T lymphocytes

Nephropathy

++++

Tacrolimus

IL2 inhibition in T lymphocytes

Nephropathy

++++

Daclizumab

IL2 receptor antibodies

None

++++

RES, reticuloendothelial system.

RES, reticuloendothelial system.

been the preferred technique for monitoring the rejection status of the cardiac allograft,"52 based on the ISHLT cardiac allograft rejection grading system.11 w53 Different non-invasive algorithms for cardiac allograft rejection monitoring have been proposed. Early after cardiac transplantation, raised concentrations of inflammatory cells and soluble inflammatory molecules and lower concentrations of immunocompetence markers are associated with impaired allograft function in the absence of cellular rejection. Based on this, an algorithm incorporating clinical status, graft function, mononuclear cell subset analysis, and endomyocardial biopsy has been proposed.12 Use of an algorithm combining endomyocardial biopsy, lymphocyte growth assays, and anti-HLA antibody measurements enables prospective stratification of cardiac transplant recipients into risk categories for progression to high grade rejection. Low risk individuals require fewer biopsies, moderate risk individuals require an ongoing schedule of surveillance biopsies, and high risk individuals require rational organisation of interventional strategies aimed at preventing rejection.13

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