Martina Milicevic

A successful transplantation implies that immunosuppressive drugs will have to be taken during the whole patient's life. Poor drug compliance is a multifactorial problem, that is particularly dangerous in organ transplantation as it can lead to loss of graft function and return to dialysis treatment. The medical doctor must stimulate the patient's adherence to the strict therapeutic drug protocol. The patient must also be reminded at each medical consultation of the importance of such rigorous drug intake. This bad (or non) compliance is particularly well demonstrated a long time after transplantation. The medical staff, all the health participants, but also the family members must continuously fight against non compliance, which is inherent to any chronic disease.

The goal of immunosuppression in transplantation is to prevent acute rejection and, more recently, chronic renal graft rejection related in part to side-effects of immunosuppressive therapy (hypertension, diabetes, dyslipidaemia,..). The development of new drugs in renal transplantation has improved graft survival, but also the patient's quality of life. A better understanding of the side-effects of immunosuppressive therapy and the observation of optimal drug associations to reduce these side-effects have often led to propose modifications of the immunosuppressive regimen, mainly at the end of the first trimester after renal transplantation. The aim of this overview is to describe the available oral immunosuppressive agents, especially the new ones, their advantages, but also the danger when different drugs are added in acute illness.

Les relations entre cerveau et hypertension arterielle sont etroites. Le cerveau, par l'entremise de l'hypothalamus, controle la regulation rapide de la pression arterielle. L'elevation aigue de la pression arterielle, si elle depasse les capacites d'autoregulation, genere des situations neurologiques de type encephalopathie qui necessitent une intervention urgente. En situation chronique, l'hypertension arterielle est une cause frequente d'accidents vasculaires cerebraux, ischemiques ou hemorragiques, chez un patient soit naif pour ce probleme, soit ayant deja souffert d'une pathologie vasculaire cerebrale. L'hypertension participe aussi a la survenue de la demence vasculaire, ainsi qu'a la maladie d'Alzheimer. La correction complete de l'elevation de pression arterielle (associee a une action sur tous les facteurs d'atherosclerose) protege le cerveau plus qu'une classe antihypertensive particuliere, sauf peut-etre les beta-bloquants. Le risque demarre deja pour des Dressions normales.