title: Liver transplantation with a twenty-four hour delay and an initial low dose of cyclosporine.
abstract: OBJECTIVE
  Cyclosporine A based immunosuppression protocols have improved the results of liver transplantation. However, there is no general agreement concerning the most appropriate initial dose of cyclosporine or the precise moment we should start its administration.
  
  
  METHODS
  Two cyclosporine A administration procedures in liver transplantation were analyzed by means of a prospective study using 91 consecutive patients and dividing them into two groups: Group A: 50 consecutive transplants in which cyclosporine was started since the surgery at 4 mg/kg/day, and Group B: the following 41 consecutive transplants in which cyclosporine was started 24 hours after transplantation at 2 mg/kg/day.
  
  
  RESULTS
  Cyclosporine levels were higher in Group A in the first month (without significant differences). There were differences in the need for hemodialysis (14% vs 0%, p < 0.01), in the length of time (h) on mechanical ventilation (147.5 +/- 36 vs 48.7 +/- 15.7, p < 0.05) and in the time (d) spent in intensive care (10.5 +/- 1.6 vs 6.5 +/- 0.8, p < 0.05). There were no differences in the incidence of acute rejection, arterial blood pressure, septic and neurological complications, or in the actuarial survival rate for patients and grafts at 36 months.
  
  
  CONCLUSIONS
  Delayed administration of cyclosporine simplifies the treatment of patients in the first 24 hours, it has several beneficial features and does not appear to be associated with a high acute rejection rate. On the basis of these results, our group has adopted delayed and low-dosage cyclosporine procedure.
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Gómez
authors.forename: E
authors.initials: E
authors.lastname: Moreno
authors.forename: C
authors.initials: C
authors.lastname: Loinaz
authors.forename: I
authors.initials: I
authors.lastname: Gonzalez
authors.forename: P
authors.initials: P
authors.lastname: Michelone
authors.forename: I
authors.initials: I
authors.lastname: Garcia
authors.forename: C
authors.initials: C
authors.lastname: Jimenez
authors.forename: A
authors.initials: A
authors.lastname: Lopez
authors.forename: A
authors.initials: A
authors.lastname: Chamorro
authors.forename: M
authors.initials: M
authors.lastname: Abradelo
authors.forename: C
authors.initials: C
authors.lastname: Castellón
mesh_terms: D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016031:Liver Transplantation / Q000276:immunology*; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine