Cyclosporin A in cardiac transplantation: medium-term results in 62 patients.
Between March, 1982, and October, 1984, 62 patients underwent orthotopic cardiac transplantation in our institution. Immunosuppression was based on cyclosporin A (Cy A) and low-dose steroids with an initial 10-day course of antithymocyte globulin. Follow-up ranged between 39 and 71 months (mean, 51.7 months). Actuarial survival at 1 year through 5 years was 80.6%, 77.4%, 74.2%, 71.4%, and 63.5%, respectively. Graft atheroma led to graft failure in 6 patients, 4 of whom died between 23 and 55 months after transplantation and 2 of whom had a repeat transplantation at 32 and 53 months. Diastolic hypertension (90 mm Hg or higher) developed in 88% of patients at 1 year. Chronic renal impairment was evident in all patients who survived for 2 years. Mean serum creatinine preoperatively and at 1 year through 4 years was 1.49 +/- 0.08 mg/100 ml (+/- the standard error), 2.01 +/- 0.09 mg/100 2.07 +/- 0.09 mg/100 ml, 2.26 +/- 0.19 mg/100 ml, and 2.32 +/- 0.33 mg/100 ml, respectively. End-stage renal failure requiring regular hemodialysis developed in 3 patients, 2 of whom died. We conclude that in addition to graft atheroma, Cy A-related nephrotoxicity is emerging as a major cause of medium-term and long-term morbidity and mortality. The use of lower doses of Cy A in a triple-therapy protocol, that is, Cy A, azathioprine, and low-dose steroids, could help reduce the extent of renal impairment.
Hakim
M
M
Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, England.
Wallwork
J
J
English
T
T
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000401:mortality; D003524:Cyclosporins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000209:etiology; D007674:Kidney Diseases / Q000139:chemically induced / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009399:Nephrons; D011183:Postoperative Complications; D014777:Virus Diseases / Q000209:etiology
D003524:Cyclosporins