Generic drug immunosuppression in thoracic transplantation: an ISHLT educational advisory.

c he 1990s ushered in approval of several novel immuosuppressant drugs, including mycophenolate mofetil, acrolimus, cyclosporine microemulsion, everolimus and irolimus, with consequent improvement in clinical utcomes. Subsequently, the transplant community has een challenged with the development and introducion of generic immunosuppression drugs. These drugs epresent a narrow therapeutic index and are thus lassified as critical-dose agents. Sengai Gibon, a Japaese zen monk, wrote “Whether for life, whether for eath—(it depends on) the right spoon-measure.” The urpose of this educational advisory is to provide an nternational perspective on regulatory and clinical oncerns with generic immunosuppression medicaions in thoracic transplantation.