title: Ten-year experience with cyclosporine as primary immunosuppression in recipients of renal allografts.
abstract: 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.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115.
authors.forename: N L
authors.initials: NL
authors.lastname: Tilney
authors.forename: A
authors.initials: A
authors.lastname: Chang
authors.forename: E L
authors.initials: EL
authors.lastname: Milford
authors.forename: W D
authors.initials: WD
authors.lastname: Whitley
authors.forename: J M
authors.initials: JM
authors.lastname: Lazarus
authors.forename: E L
authors.initials: EL
authors.lastname: Ramos
authors.forename: T B
authors.initials: TB
authors.lastname: Strom
authors.forename: C B
authors.initials: CB
authors.lastname: Carpenter
authors.forename: R L
authors.initials: RL
authors.lastname: Kirkman
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D001900:Boston / Q000453:epidemiology; D002423:Cause of Death; D002985:Clinical Protocols / Q000592:standards*; D003524:Cyclosporins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000187:drug effects / Q000276:immunology*; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D015996:Survival Rate; D014181:Transplantation Immunology
chemical_list: D003524:Cyclosporins; D001379:Azathioprine; D011241:Prednisone