Cyclosporin conversion versus conventional immunosuppression: long-term follow-up and histological evaluation.
129 patients who received a cadaver renal transplant entered a randomised prospective trial of cyclosporin for 3 months with conversion to azathioprine and prednisolone compared with conventional therapy of azathioprine and prednisolone. In the 64 patients who received cyclosporin, actuarial patient survival was 92%, and actuarial graft survival was 72% and 67% at 1 and 4 years after transplantation. Graft survival was significantly better (p less than 0.03) than in the 65 patients who received conventional therapy, in whom actuarial patient survival was 94%, and actuarial graft survival was 59% and 47% at 1 and 4 years. Renal function and other side-effects improved quickly after conversion with the better renal function maintained throughout follow-up. Renal biopsies at 90 days and 1 year in all patients did not show consistent improvement after conversion from cyclosporin in the histological features that might be attributable to cyclosporin toxicity. After conversion, 32% of the patients had acute rejection, generally within 30 days. 1 graft was lost to early acute rejection after conversion and another was lost 3 months later from acute-on-chronic rejection. A total of 8 grafts were lost to chronic rejection in the cyclosporin-treated group and 6 in the conventional group. The improvement in renal function obtained with this protocol of short-term cyclosporin with conversion to azathioprine and prednisolone has to be balanced against the risk of acute rejection and even loss of the graft after conversion.
D000284:Administration, Oral; D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D003524:Cyclosporins / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D011897:Random Allocation; D013997:Time Factors
D003524:Cyclosporins; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone