The long-acting dopamine agonist bromocriptine mesylate as additive immunosuppressive drug after kidney transplantation.
BACKGROUND
Acute rejection is an important risk factor for kidney graft loss. As evidence suggests that prolactin has important immunostimulatory properties, we conducted a randomized, prospective open trial in which bromocriptine, a drug suppressing prolactin secretion, was administered as an additive immunosuppressive drug after first cadaver kidney transplantation.


METHODS
In the treatment group bromocriptine was given intramuscularly to 22 patients after their first kidney transplantation along with conventional immunosuppression (cyclosporin A, glucocorticoids). Twenty-three patients receiving only conventional immunosuppression served as control subjects. The incidence of acute graft rejections, graft losses, and infections was evaluated.


RESULTS
Serum prolactin concentrations were slightly elevated above normal values before transplantation (32 +/- 5.3 ng/ml) and decreased to values between 13 and 16 ng/ml in the control group and were totally suppressed in the bromocriptine group. After 6 months of follow-up overall patient and allograft survival was 97.7% and 91% respectively. Acute rejection episodes occurred in 31 patients (77.5%): 15 in the bromocriptine group vs 20 in the control group (n.s.). In each group eight patients experienced a cytomegalovirus infection. The incidence of severe bacterial infections (i.e. pneumonia and sepsis) was five and six respectively. The necessity of haemodialysis after transplantation was 3.1% in the patients on bromocriptine and 23% in those without.


CONCLUSIONS
Suppression of circulating prolactin concentration by bromocriptine did not improve the clinical outcome of patients after kidney transplantation receiving cyclosporin and prednisolone.
Clodi
M
M
Deparment of Medicine, University of Vienna, Austria.
Kotzmann
H
H
Riedl
M
M
Schmidt
A
A
Barnas
U
U
Mühlbacher
F
F
Mustafa
G
G
Hörl
W H
WH
Waldhäusl
W
W
Mayer
G
G
Luger
A
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D001971:Bromocriptine / Q000008:administration & dosage* / Q000009:adverse effects; D016572:Cyclosporine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D011388:Prolactin / Q000097:blood; D011446:Prospective Studies
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001971:Bromocriptine; D016572:Cyclosporine; D011388:Prolactin; D011239:Prednisolone