Cyclosporine: an immunosuppressive panacea?
Between March 29, 1979, and March 1, 1985, 62 heart transplants were done in 61 patients at the University Medical Center, University of Arizona. There were two treatment groups with nearly equal numbers in each; conventional immunosuppression (1979 to 1982) and cyclosporine (1982 to the present). Comparison of actuarial survival, number of rejection episodes, number of fatal rejection episodes, number of infections, and number of "other complications" failed to reveal any significant difference between the two groups. The cyclosporine-treated patients had a documented increase in blood urea nitrogen and serum creatinine accompanied by an increase in diastolic blood pressure. The length of hospital stay of the cyclosporine group was approximately one half of that of the conventionally treated patients, and they required fewer rehospitalizations. The cost for initial hospitalization was not significantly different between the two groups. Therefore, in 1979 dollars, the cost for cyclosporine-treated patients has decreased. This difference in cost was only minimally diminished by the difference in expenditure for outpatient pharmaceuticals, which was four times higher in the cyclosporine group. We believe that cyclosporine is a potent immunosuppressive agent but that it has toxic, possibly irreversible effects on the kidney. In view of the minimal differences that we were able to demonstrate in survival rejection and infection, it seems prudent to reduce or modify present doses of cyclosporine in an attempt to avoid irreversible renal damage.
Copeland
J G
JG
Emery
R W
RW
Levinson
M M
MM
Icenogle
T B
TB
Riley
J E
JE
McAleer
M J
MJ
Copeland
J A
JA
Dietz
R
R
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D003365:Costs and Cost Analysis; D003404:Creatinine / Q000097:blood; D003524:Cyclosporins / Q000627:therapeutic use* / Q000633:toxicity; D005260:Female; D006084:Graft Rejection / Q000187:drug effects*; D006334:Heart Function Tests; D016027:Heart Transplantation; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007165:Immunosuppression Therapy / Q000191:economics; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D017053:Infection Control; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged
D003524:Cyclosporins; D007166:Immunosuppressive Agents; D003404:Creatinine