title: Highly sensitized patients with delayed graft function: a management protocol.
abstract: The postoperative management of the highly sensitized renal transplant recipient with delayed graft function on cyclosporine is complicated. Allografts with delayed graft function are reported to have a 20 to 30% poorer 1-year survival than allografts without delayed graft function. Several factors may be implicated in this poorer 1-year survival. A decrease in or cessation of cyclosporine dosage frequently is used in an attempt to minimize nephrotoxicity. Such under-immunosuppression can result in irreversible rejection. Occasionally, a pessimistic view of the prognosis for the transplant may result in early abandonment of the allograft with discontinuation of immunosuppression and allograft nephrectomy. We report on 3 highly sensitized patients whose kidneys had delayed graft function and were deliberately maintained on high doses of cyclosporine throughout the period of delayed graft function. Each graft achieved function (2, 4 and 5 months) after transplantation. The serum creatinine levels 20, 28 and 38 months after transplantation were 2.7, 2.0 and 1.0 mg./dl., respectively. We suggest that the maintenance of high cyclosporine levels throughout the delayed graft function period is useful in highly sensitized recipients and was an important factor in their successful outcome. A management protocol for such patients is proposed.
authors.affiliation: Department of Surgery, University Hospital, Pittsburgh, Pennsylvania.
authors.forename: D P
authors.initials: DP
authors.lastname: Hickey
authors.forename: C A
authors.initials: CA
authors.lastname: Vivas
authors.forename: M L
authors.initials: ML
authors.lastname: Jordan
authors.forename: W B
authors.initials: WB
authors.lastname: Lopatin
authors.forename: R
authors.initials: R
authors.lastname: Hrebinko
authors.forename: R
authors.initials: R
authors.lastname: O'Donovan
authors.forename: T R
authors.initials: TR
authors.lastname: Hakala
mesh_terms: D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D002102:Cadaver; D003524:Cyclosporins / Q000008:administration & dosage; D005260:Female; D006084:Graft Rejection / Q000187:drug effects / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D011184:Postoperative Period; D011241:Prednisone / Q000008:administration & dosage; D012086:Reoperation; D013997:Time Factors
chemical_list: D003524:Cyclosporins; D001379:Azathioprine; D011241:Prednisone