A prospective, randomized study of coadministration of ketoconazole and cyclosporine a in kidney transplant recipients: ten-year follow-up.
BACKGROUND
In a prospective, randomized study, we previously proved the safety and financial benefits of the coadministration of ketoconazole (keto) and cyclosporine A (CsA) in patients. We report the 10-year follow-up of these patients and the controls.


METHODS
In January 1992, 100 living-related kidney transplant recipients were randomized into two groups: Group 1 (51 patients) received 100 mg/day keto, and group 2 (49 patients) did not receive keto (control). Both groups were evaluated regarding graft function, CsA dose and levels, liver function tests, serum calcium and phosphorus, bone mineral density, and histopathologic assessment.


RESULTS
Follow-up for 10 years showed that CsA dose reduction was maximum after 1 month (76.5%) and decreased gradually after 10 years (64.6%). Acute rejection was diagnosed in 22% and 27% in the keto and control groups, respectively (P =0.27). In the control group, the acute rejection episodes were more frequent with poorer response to treatment. Chronic allograft nephropathy was statistically significantly less in the keto group. Hepatotoxicity and metabolic complications were similar in both groups. The annual cost saving of CsA was 60% after 1 year and 50% at the end of the study.


CONCLUSIONS
We conclude that the long-term use of keto for CsA dose reduction in kidney transplant recipients is safe, tolerable, and cost-sparing and is associated with stable graft function.
el-Agroudy
Amgad E
AE
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. amgadelbaz@ahram0505.net
Sobh
Mohamed A
MA
Hamdy
Ahmed F
AF
Ghoneim
Mohamed A
MA
D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D016572:Cyclosporine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007654:Ketoconazole / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D009181:Mycoses / Q000517:prevention & control; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D007654:Ketoconazole