High- and low-dose regimens of cyclosporin in renal transplantation: immunosuppressive efficacy and side-effects.
The immunosuppressive effectiveness and nephrotoxic side-effects of either high-dose cyclosporin (CsA) (16 mg/kg per day) or low-dose (9 mg/kg per day) in combination with azathioprine (Aza) (1 mg/kg per day) were studied in 80 renal transplant patients who also received low-dose corticosteroids. At 3 months, patients who received high-dose CsA were randomly assigned to either continuation of CsA or conversion to Aza, whereas in the triple-therapy group either CsA or Aza was discontinued. No differences in patient (97.5%) or graft survival (90%-92.5%) were found at 1 year. There were no differences in the incidence of primary non-functioning kidneys. The incidence of acute rejection episodes was 45% in the high-dose CsA group and 55% in the group treated with low CsA doses together with Aza (not significant). At 3 months the mean creatinine clearance was 60 +/- 4 ml/min (mean +/- SEM) in the high-dose group (mean cumulative CsA dose 0.96 g/kg) compared with 55 +/- 3 ml/min in the low-dose group (mean cumulative CsA dose 0.60 g/kg). At 1 year no differences in the degree of proteinuria or the incidence of hypertension was found between the different groups. The best mean creatinine clearance at 1 year (77 +/- 5 ml/min) was found in patients who received high doses of CsA for 3 months followed by conversion.
Kootte
A M
AM
Department of Nephrology, University Hospital Leiden, The Netherlands.
Lensen
L M
LM
van Bockel
J H
JH
van Es
L A
LA
Paul
L C
LC
D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D003524:Cyclosporins / Q000008:administration & dosage* / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000187:drug effects*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011897:Random Allocation
D003524:Cyclosporins; D004338:Drug Combinations; D001379:Azathioprine; D011241:Prednisone