Examination of parameters influencing the benefit:detriment ratio of cyclosporine in renal transplantation. The Canadian Transplant Study Group.
The benefit:detriment ratio of Cyclosporine (CsA) in renal transplantation was examined by analysis of the data accumulated within the Canadian Transplant Study Group (CTSG). Transplantation was performed according to commonly defined protocols, and 496 patients were analysed following cadaveric or live-related transplantation. One-year patient and graft survival were 96% and 86%, respectively, following living-related HLA nonidentical transplantation, 92% and 75% following primary cadaveric transplantation, and 97% and 58% following cadaveric retransplantation. A clear beneficial effect of blood transfusion was observed following primary cadaveric renal transplantation (P = 0.04), with a trend towards improved graft survival in donor/recipient pairs matched at the B or Dr locus (89% v 73%, P = NS). Prolonged machine preservation (greater than 24 hours) of the kidney or long (greater than than 45 minutes) surgical anastomosis time, and an elevated serum CsA level adversely influenced allograft function. Graft function in patients receiving CsA stabilized by approximately 6 months posttransplant, and subsequently remained constant as determined by both serum creatinine and calculation of creatinine clearance. Hypertension was more common (P = 0.003) in patients receiving CsA, and vascular complications were more frequent although this difference was not statistically significant. Infectious complications were comparable between the two groups. Two lymphomas were confirmed in patients receiving CsA. The mean cost of CsA throughout the first 12 months posttransplant based on a 60 kg patient weight was $4,490, and reduced by $3,397 each subsequent year of maintenance treatment.
D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D003524:Cyclosporins / Q000009:adverse effects / Q000627:therapeutic use*; D006085:Graft Survival / Q000187:drug effects*; D006680:HLA Antigens; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000188:drug therapy; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D007683:Kidney Tubular Necrosis, Acute / Q000209:etiology; D008875:Middle Aged; D009926:Organ Preservation; D011183:Postoperative Complications; D011184:Postoperative Period; D011897:Random Allocation; D012306:Risk
D003524:Cyclosporins; D006680:HLA Antigens