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    TNF, tumor necrosis buy viagra mastercard factor. Suppresses IL-2–dependent T-cell proliferation Same as tacrolimus Inhibits T- and B-cell proliferation by interfering with purine synthesis Selective inhibition of T- and B-cell proliferation by interfering with purine synthesis Cytokine inhibitor (IL-1, IL-5, IL-4, TNF, and IFNγ) Inhibition of the mammalian target of rapamycin (mTOR) decreasing B-cell and T-cell proliferation Blocks T-cell CD2 receptor, preventing stimulation by antigen Monoclonal antibody that blocks IL-3 receptor inhibiting T-cell activation TOXICITIES Renal insufficiency, neurologic, diabetes mellitus, diarrhea Hypertension, renal insufficiency, neurologic, hyperlipidemia, hirsutism Bone marrow depression, hepatotoxicity, dyspepsia Bone marrow depression, diarrhea, dyspepsia Diabetes mellitus, obesity, hypertension, osteopenia, infection, emotional lability Neutropenia, thrombocytopenia, pneumonitis, hyperlipidemia, hepatic artery thrombosis* Cytokine release syndrome, pulmonary edema, increased risk of infections/ lymphoproliferative disorders Hypersensitivity reactions with basiliximab Sirolimus OKT6 Daclizumab/basiliximab/ thymoglobulin *Sirolimus is associated with a black box warning due to hepatic artery thrombosis. The specific immunosuppressive regimen varies from center to center.

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    Table 26-1.  Mechanism of Action and Side Effects of Immunosuppressants DRUG Tacrolimus Cyclosporine Azathioprine Mycophenolate mofetil Mycophenolic acid Corticosteroids MECHANISM OF ACTION Calcineurin inhibitor. Current immunosuppressive therapy usually involves two or three agents to prevent allograft rejection in the immediate postoperative period.

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