title: A randomized controlled trial of cyclosporine withdrawal in renal-transplant recipients: 15-year results.
abstract: BACKGROUND
  In renal transplantation, the immunosuppressive efficacy of cyclosporine is counterbalanced by its nephrotoxicity. Although cyclosporine improves short-term graft survival, its long-term effects are unclear.
  
  
  METHODS
  Recipients of first cadaver renal transplants were randomized into three groups between 1983 and 1986: azathioprine and prednisolone alone (AP, n = 158), long term cyclosporine alone (Cy, n = 166), and short-term cyclosporine followed by azathioprine and prednisolone (CyAP, n = 165). All groups received methylprednisolone induction.
  
  
  RESULTS
  There were no significant differences in patient survival at 15 years (48 vs. 56 vs. 51%, P = 0.14), and 15-year graft survival (censored for death) in those patients in the CyAP group (47 vs. 44 vs. 59%, P = 0.06) was not significantly different statistically. When deaths or graft losses before 12 months were censored, the differences in 15-year graft survival between the groups were significant (58%, 51%, 70%, P = 0.01). The CyAP group also had lower mean serum creatinine at all time points beyond 3 months posttransplant out to 10 years (143 vs. 169 vs. 131 micromoles/L, P = 0.04). Per protocol analysis, after censoring patients at change in therapy, increased the observed differences in 15-year graft survival between the groups (54 vs. 38 vs. 65%, P = 0.01).
  
  
  CONCLUSIONS
  Survival and function of first cadaveric kidney transplants is improved by use of short-term cyclosporine followed by azathioprine and prednisolone. Long-term cyclosporine use reduces long-term graft survival.
authors.affiliation: The Canberra Hospital, Woden, ACT 2605, Australia. martin.gallagher@act.gov.au
authors.forename: Martin P
authors.initials: MP
authors.lastname: Gallagher
authors.forename: Bruce
authors.initials: B
authors.lastname: Hall
authors.forename: Jonathan
authors.initials: J
authors.lastname: Craig
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Berry
authors.forename: David J
authors.initials: DJ
authors.lastname: Tiller
authors.forename: Josette
authors.initials: J
authors.lastname: Eris
mesh_terms: D000328:Adult; D002102:Cadaver; D016572:Cyclosporine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008297:Male
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine