Influence of technical factors and different immunosuppressive regimens on kidney graft survival. Retrospective analysis on 300 kidney transplants.
300 patients underwent kidney transplantation. Uretero-neocystostomy was performed by means of the Politano-Leadbetter technique in the first 185 patients and direct ureterovesical anastomosis in the other 115 patients. Immunosuppression included conventional therapy (steroids, antilymphocyte globulins, azathioprine) and the association cyclosporine A and steroids. Retrospective analysis on these 300 patients indicates that the improved 1 year graft survival rate (85% vs 64%) we observed in the latest years has depended to the same extent, on improved surgical technique and on advent of cyclosporine A in our therapeutic protocols. Cyclosporine A at low starting doses immediately adjusted on whole blood trough levels (200-400 ng/ml) proved to be superior to other therapeutic schedules reported in this study (1-year graft survival rate: 94% vs 84%-73%). Direct ureterovesical anastomosis was characterized by a net reduction of urologic complications (2.5% vs 9.7%).
D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003524:Cyclosporins / Q000627:therapeutic use; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects; D016030:Kidney Transplantation; D008775:Methylprednisolone / Q000627:therapeutic use; D011183:Postoperative Complications; D011241:Prednisone / Q000627:therapeutic use; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous / Q000401:mortality; D014513:Ureter / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery
D000961:Antilymphocyte Serum; D003524:Cyclosporins; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone; D008775:Methylprednisolone