The impact of early postoperative cyclosporine serum levels on the incidence of cardiac allograft rejection.
The introduction of cyclosporine A (CyA) into the immunosuppressive therapy has significantly improved the results of heart transplantation (HTX). Its nephrotoxicity and hepatotoxicity, however, often limit the perioperative and postoperative use of this drug. The purpose of this retrospective study was to evaluate the effect of early postoperative CyA blood levels on the incidence of early as well as late cardiac rejection and patients' survival. Between October 1985 and June 1991, HTX was performed in 311 patients. Standard immunosuppression consisted of azathioprine (1-2 mg/kg), prednisolone (0.5 to 0.1 mg/kg) and CyA. Rabbit-antithymocyte-globulin (RATG - 1.5 mg/kg) was administered for the first 4 days postoperatively. Moderate rejection was treated with 3 x 500 mg methylprednisolone, severe rejection with RATG (1.5 mg/kg three times a day). Patients were excluded from this study because of a positive cross-matching, early death unrelated to rejection or alternate forms of immunosuppression (n = 111). Follow-up was complete in 200 patients (mean age 44 +/- 11; 18 female, 182 male; 204,233 patient days) with a total of 5380 biopsies. The cohort was divided into group I (no CyA for day 0 to 2; n = 108) and group II (CyA during day 0 to 2; n = 92) according to the onset of CyA therapy. In 101 patients (group A) the mean CyA blood level was less than 150 ng/ml from day 0 to 14 and in 99 patients more than 150 ng/ml (group B).(ABSTRACT TRUNCATED AT 250 WORDS)
Hausen
B
B
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Demertzis
S
S
Schäfers
H J
HJ
Wahlers
T H
TH
Wagenbreth
I
I
Haverich
A
A
D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D015331:Cohort Studies; D016572:Cyclosporine / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors
D000961:Antilymphocyte Serum; D016572:Cyclosporine; D011239:Prednisolone; D001379:Azathioprine; D008775:Methylprednisolone