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Related Experiment Videos

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
PubMed
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.

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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:

Related Experiment Videos

  • 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.