Cyclosporin conversion versus conventional immunosuppression: long-term follow-up and histological evaluation

Area of Science:

• Nephrology
• Transplantation Immunology
• Immunosuppression Therapy

Background:

• Cadaver renal transplantation is a common procedure for end-stage renal disease.
• Optimizing immunosuppression protocols is crucial for long-term graft survival and patient outcomes.
• Cyclosporin, azathioprine, and prednisolone are key immunosuppressive agents in transplantation.

Purpose of the Study:

• To compare the efficacy and safety of a short-term cyclosporin regimen followed by conversion to azathioprine and prednisolone versus conventional azathioprine and prednisolone therapy in cadaver renal transplant recipients.
• To evaluate the impact of this protocol on patient and graft survival, renal function, and side effects.

Main Methods:

• A randomized prospective trial involving 129 patients undergoing cadaver renal transplantation.
• Group 1: 3 months of cyclosporin followed by azathioprine and prednisolone.
• Group 2: Conventional therapy with azathioprine and prednisolone.

Main Results:

• Actuarial graft survival at 1 and 4 years was significantly better in the cyclosporin conversion group (72% and 67%) compared to the conventional therapy group (59% and 47%) (p<0.03).
• Improved renal function and reduced side effects were observed after conversion, maintained throughout follow-up.
• 32% of patients experienced acute rejection within 30 days post-conversion, with some graft losses attributed to acute or acute-on-chronic rejection.

Conclusions:

• Short-term cyclosporin with conversion to azathioprine and prednisolone offers superior graft survival in renal transplantation.
• This protocol demonstrates improved renal function post-transplant.
• The benefits must be weighed against an increased risk of acute rejection episodes and potential graft loss after conversion.