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Summary and View of the Future
The Florence meeting successfully illustrated hew academic clinical and research workers and pharmaceutical companies are weaving a current renaissance in immunosuppression and a hetter future for transplant patients. Four key needs tacing the transplant community are heing addressed, arid in some areas impressive progress has heen made.
Achieving optimal immunosuppression
Discovering new therapeutic targets
Overcoming chronic rejection
Developing new technologies to tackle the organdonor shortage
Immunosuppression has improved vastly since the advent of cyclosporin A in 1083. The goals ot immunosuppressive technology in the next millenium will he to produce agents that act synergistically, are selective and specific. In this way, the quality of patients' lives, convenience of taking medication and cost-eftectiveness ot transplantation will he improved. ventually, instead of using standard dose schedriles, each patient will receive agents tailored to his individual needs. Targeted drug design will he the primary strategy tor the development ot novel immunosuppressants.
For the first time since the introduction
of cyclosporin A, there are new approaches to immunosuppression just
" Immunosupresion is undergoing a renaissance and transplant patients in the next millennium should see the fruits of these advances "
The advent of rapamycin and FAD, in particular, will mark the first significant new innovation for maintenance therapy in transplant recipients, which could also offer protection against chronic rejection. Induction ot tolerance may seem out of reach at time, hut success is heing achieved in animal model Complement inhihition and the use of gene therapy al hold hope for the transplant patient in the future ar may well allow us to reduce rejection dramatically. Much progress in controlling acute rejection has hee made hut chronic rejection still remains a huge hurdlE There is a great deal of research heing carried Out academic institutions all around the world. Novartis to is investing heavily and collahorating with researc groups to turther our understanding. The prevention cgraft-vessel disease will he a major challenge in the new millenium, and more specifically the endothelia cell is likely to he a particular target for drugs developer to comhat chronic rejection. However, all this research and effort could hecome nothing more than an academic exercise if there aw not enough donor organs. Efforts to increase humar organ donation must remain at the top of the agenda. The hope for xenotransplantation using pig organs seems potentially to he a permanent way to meet the demand for organs and decrease time on waiting lists for transplantation, hut is still many years away from hecoming a routine procedure. The introduction of xenotransplantation into clinical practice is likely to follow a stepwise approach, in order to ensure that this is achieved safely and successfully. The transplant community is used to facing challenges. Through partnership and collahoration, immuno-suppression is undergoing a renaissance and transplant patients in the next millenium should see the fruits of these advances.