Management of the renal allograft recipient: immunosuppressive protocols for long-term success.
To determine the benefits of long-term cyclosporine (CsA) immunosuppression, renal allograft recipients were randomly assigned to a protocol of either: CsA+azathioprine (Aza)+prednisone (TD), or to a protocol in which CsA was discontinued from the regimen of Aza+prednisone (CsA D/C). With a mean follow-up of nearly 7 years since transplantation, 30/47 (64%) CsA D/C and 27/45 (60%) TD had functioning allografts. Although long-term survivals were similar, hazards of the CsA D/C protocol were evident (40% rate of acute rejection following CsA D/C). Conversely, continued CsA in the TD protocol provided the opportunity for prednisone reduction, or even complete prednisone withdrawal in selected patients. A TD protocol which can provide equivalent long-term success, and eventually lower or omit prednisone, is preferable to a protocol of CsA D/C.
Delmonico
F L
FL
Transplantation Unit of the General Surgical Services, Massachusetts General Hospital, Boston 02114.
Tolkoff-Rubin
N
N
Auchincloss
H
H
Williams
W W
WW
Fang
L T
LT
Bazari
H
H
Farrell
M L
ML
Cosimi
A B
AB
D000208:Acute Disease; D001379:Azathioprine / Q000008:administration & dosage; D002908:Chronic Disease; D016572:Cyclosporine / Q000008:administration & dosage; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000401:mortality; D011241:Prednisone / Q000008:administration & dosage
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine; D011241:Prednisone