Cyclosporin A: early or delayed onset by prophylactic immunosuppression?
In a prospective randomized trial, 57 renal transplant patients received sequential immunosuppression consisting of lymphocytoglobulin (ALG), azathioprine, and steroids for 14 days (group A) and another 57 patients for only 2 days (group B). In each case therapy was continued with cyclosporin A and steroids. The purpose of this study was to find the most favourable time to switch over to continuous cyclosporin A therapy with avoidance of its nephrotoxic side-effects during the perioperative phase. As a consequence of ALG intolerance, conventional immunosuppression had to be changed in group A after a mean of 7.8 days, as opposed to 2.1 days in group B. The patients receiving a prophylactic therapy with ALG, azathioprine, and steroids for 14 days (group A) had to be dialysed at a significantly greater frequency than patients with an early start to cyclosporin A (group B) from the second to the fourth week. Patient survival rates 1 and 2 years after transplantation of group A (95 and 92%) and group B (96 and 92%) were not distinct, and there was no significant difference in graft survival rates of group A (79 and 79%) and B (89 and 82%) after the same time. A delayed start of cyclosporin A after 14 days showed no further advantage but rather a significantly greater frequency of dialysis; thus the early onset of cyclosporin A treatment post-transplant is preferable.
Chirurgische Universitätsklinik, Köln-Lindenthal, Germany.
P
P
Wienand
J
J
Isenberg
D
D
Stippel
T
T
Schröder
C
C
Baldamus
D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage* / Q000627:therapeutic use; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D011182:Postoperative Care; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors
D016572:Cyclosporine