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Spanish experience with cyclosporine.
J Pascual1, R Marcén, F J Burgos
1Servicios de Nefrología, Urología y Anatomía Patológica, Hospital Ramón y Cajal, Madrid, Spain. jpascual.hrc@salud.madrid.org
Transplantation Proceedings
|March 26, 2004
Summary
Cyclosporine (CsA) use in renal transplantation (RT) evolved over four phases, improving short-term outcomes. Optimized dosing and monitoring, particularly C2 monitoring, enhanced graft function and reduced rejection rates in de novo RT patients.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation Medicine
Background:
- Cyclosporine (CsA) has been a cornerstone of immunosuppression in de novo renal transplantation (RT).
- Evolution of CsA use involved distinct phases, each with unique protocols and outcomes.
- Long-term graft survival and causes of graft loss have been key considerations in CsA therapy.
Purpose of the Study:
- To systematize and analyze the long-term experience with cyclosporine (CsA) in de novo renal transplantation (RT) across four distinct phases.
- To evaluate the impact of evolving CsA formulations, dosing strategies, and monitoring techniques on patient and graft survival.
- To identify trends in graft loss causes and assess improvements in renal allograft function over two decades.
Main Methods:
- Retrospective analysis of 128 (Phase 1), 209 (Phase 2), and 110 (Phase 3) de novo RT recipients treated with CsA-based immunosuppression.
- Comparison of patient and graft survival rates, acute rejection episodes, and causes of graft loss across different treatment eras.
- Implementation and evaluation of microemulsion CsA formulation (Neoral) and C2 monitoring versus C0 monitoring.
Main Results:
- Phase 1 showed higher patient survival with CsA vs. azathioprine, but long-term graft survival differences narrowed.
- Subsequent phases demonstrated improved outcomes through lower CsA doses, faster steroid tapering, and better management of CsA nephrotoxicity.
- Neoral formulation with C2 monitoring led to low acute rejection rates and improved renal allograft function compared to C0 monitoring.
Conclusions:
- CsA use in de novo RT has evolved significantly over two decades, with progressive improvements in short-term outcomes.
- Optimized CsA dosing and monitoring, including C2 monitoring and combination with newer agents, have enhanced graft function and survival.
- Future advancements in immunosuppressive drugs and protocols promise further optimization of CsA therapy in renal transplantation.