Low-dose cyclosporine therapy in triple-drug immunosuppression for heart transplant recipients.
The toxicity of long-term immunosuppressive therapy has become a major concern in long-term follow-up of heart transplant recipients. In this respect the quality of renal function is undoubtedly linked to cyclosporin A (CsA) drug levels. In cardiac transplantation, specific CsA trough levels have historically been maintained between 250 and 350 micrograms/L in many centers without direct evidence for the necessity of such high levels while using triple-drug immunosuppression. This retrospective analysis compares the incidence of acute and chronic graft rejection as well as overall mortality between groups of patients with high (250 to 350 micrograms/L) and low (150 to 250 micrograms/L) specific CsA trough levels. A total of 332 patients who underwent heart transplantation between October 1985 and October 1992 with a minimum follow-up of 30 days were included in this study (46 women and 276 men; aged, 44 +/- 12 years; mean follow-up, 1,122 +/- 777 days). Standard triple-drug immunosuppression included first-year specific CsA target trough levels of 250 to 300 micrograms/L. Patients were grouped according to their average creatinine level in the first postoperative year (group I, < 130 mumol/L, n = 234; group II, > or = 130 mumol/L, n = 98). The overall 5-year survival excluding the early 30-day mortality was 92% (group I, 216/232) and 91% (group II, 89/98) with 75% of the mortality due to chronic rejection. The rate of rejection for the entire follow-up period was similar in both groups (first year: group I, 3.2 +/- 2.6 rejection/patient/year; group II, 3.6 +/- 2.7 rejection/patient/year; p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)
Hausen
B
B
Division of Thoracic and Cardiovascular Surgery, Surgical Center, Hannover Medical School, Germany.
Demertzis
S
S
Rohde
R
R
Albes
J M
JM
Schäfers
H J
HJ
Borst
H G
HG
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D000075202:Contraindications; D016572:Cyclosporine / Q000097:blood / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007677:Kidney Function Tests; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D015996:Survival Rate
D016572:Cyclosporine; D001379:Azathioprine; D008775:Methylprednisolone