Related Experiment Videos
Cyclosporine as primary therapy for A-matched living related donor kidney graft recipients
A S MacDonald1, P Belitsky, H Bitter-Suermann
1Transplant Service, Dalhousie University, Victoria General Hospital, Halifax, Nova Scotia, Canada.
Insights
Cyclosporine (CyA) and steroids showed superior graft survival compared to azathioprine (Aza) and prednisone (Pred) in HLA-identical sibling transplants. However, CyA use was associated with increased anti-hypertensive needs and drug toxicity.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Long-term immunosuppression is crucial for graft survival in HLA-identical sibling kidney transplants.
- Azathioprine (Aza) and prednisone (Pred) have been standard, but newer agents like Cyclosporine (CyA) offer alternative strategies.
Purpose of the Study:
- To compare the efficacy and safety of Aza/Pred versus CyA-based immunosuppression in HLA-identical sibling kidney transplant recipients.
- To evaluate graft survival rates, rejection episodes, and adverse events across different treatment regimens.
Main Methods:
- A prospective study allocated 48 HLA-identical sibling graft recipients into three groups: Aza/Pred, CyA alone, or CyA/steroids.
- Graft survival, rejection episodes, and adverse events including hypertension and drug toxicity were monitored over three years.
Main Results:
- All groups achieved 100% one-year graft survival. Three-year survival was 86% for Aza, 94% for CyA alone, and 100% for CyA/steroids.
- Rejection episodes were significantly lower in CyA groups (18%) compared to Aza (50%).
- However, CyA recipients experienced higher rates of anti-hypertensives (55% vs. 20%) and drug toxicity (12%).
Conclusions:
- Cyclosporine-based regimens, particularly with steroids, demonstrate superior three-year graft survival and reduced rejection rates in HLA-identical sibling transplants compared to azathioprine.
- The benefits of CyA must be weighed against increased risks of hypertension and drug toxicity, necessitating careful patient monitoring.
- Longer follow-up is required to fully ascertain the long-term impact of CyA in this specific patient population.
Abstract:
Between 1981-87, 48 HLA identical sibling graft recipients were allocated to one of three treatment groups: Group I-15 patients Aza and Pred; Group II-12 CyA alone; Group III-21 CyA and steroids. Only one patient died from a fatal hereditary disease. Graft survival was 100% at one year in all groups and at three years was 86% for Aza, 94% for CyA alone and 100% for CyA and steroids. Rejection episodes occurred in 50% of Aza patients versus 18% in the CyA groups. However 55% of CyA patients require anti-hypertensives versus 20% of Aza recipients, and 12% of CyA patients were switched because of drug toxicity. In a previous study of 36 Aza treated A-matched patients, five of eight losses occurred after the first 5 years--most related to long term effects of immunosuppression. We may have to wait for longer follow-up before drawing conclusions regarding the use of CyA in identically matched living related recipients.