Ten-year experience with cyclosporine as primary immunosuppression in recipients of renal allografts

• Published in: Annals of surgery Vol. 214; no. 1; pp. 42 - 49
• Main Authors: TILNEY, N. L, CHANG, A, MILFORD, E. L, WHITLEY, W. D, LAZARUS, J. M, RAMOS, E. L, STROM, T. B, CARPENTER, C. B, KIRKMAN, R. L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.07.1991
• Subjects: Adult; Azathioprine - administration & dosage; Azathioprine - therapeutic use; Biological and medical sciences; Boston - epidemiology; Cause of Death; Clinical Protocols - standards; Cyclosporins - administration & dosage; Cyclosporins - pharmacology; Cyclosporins - therapeutic use; Drug Therapy, Combination; Female; Follow-Up Studies; General pharmacology; Graft Rejection - drug effects; Graft Rejection - immunology; Graft Survival - drug effects; Graft Survival - immunology; Humans; Kidney Transplantation - immunology; Kidney Transplantation - mortality; Male; Medical sciences; Pharmacology. Drug treatments; Prednisone - administration & dosage; Prednisone - therapeutic use; Survival Rate; Transplantation Immunology; Boston; Human; Chemotherapy; Urinary system disease; Treatment; Surgery; Immunosuppressive agent; Graft surgical; Result
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-199107000-00007

Cyclosporine has been used as primary immunosuppression in renal allograft recipients in our unit for the past decade. The overall clinical experience and long-term effects of the agent are reviewed. There were 461 consecutive recipients of kidney grafts; 379 received grafts from cadaver donors (CAD) and 82 from living related donors (LRD). Four separate clinical protocols were used sequentially using progressively decreasing doses of CyA; azathioprine was added in group 4 recipients of LRD grafts, and in patients receiving secondary CAD grafts (group 5). The patient mortality rate was less than 5%, with sepsis being the prime contributor. The majority of kidney grafts were lost within the first 2 months after operation; those that never functioned were found almost invariably to have been irreversibly rejected. During the subsequent years of follow-up, attrition of CAD grafts was significantly greater than LRD grafts. In contrast, the attrition rate of primary and secondary CAD grafts was the same after the first 3 months, emphasizing the importance of early immunologic graft destruction. Primary nonfunction occurred in 49% of CAD kidneys and 17% of LRD grafts; however 71% of initially nonfunctioning LRD grafts never functioned at all compared to 34% of CAD grafts, the majority of such organs undergoing fulminate rejection. Individual graft loss after 1 year was almost inevitably due to chronic rejection; there were no differences in long-term allograft function among the treatment groups. Although CyA has improved overall results of kidney transplantation, chronic rejection remains a major unresolved problem.