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Triple therapy and initial renal graft perfusion
1Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Denmark.
Danish Medical Bulletin
|August 1, 1988
Summary
Triple therapy, including a delayed start for cyclosporine A (Sandimmune), did not decrease transplanted kidney perfusion. This monitoring study in 25 patients suggests a safer immunosuppression protocol for renal transplant recipients.
Area of Science:
- Nephrology
- Immunology
- Radiology
Background:
- Cyclosporine A (Sandimmune) can impair transplanted kidney perfusion, particularly in ischemic grafts.
- Assessing early graft perfusion is crucial for post-transplant outcomes.
Purpose of the Study:
- To evaluate the effect of triple immunosuppression therapy, with delayed cyclosporine A administration, on early transplanted kidney perfusion.
- To monitor renal blood flow in transplant recipients using technetium-99m pertechnetate angiography.
Main Methods:
- Intravenous 99mTc pertechnetate angiography was used to monitor graft perfusion in 25 renal transplant patients.
- Scans were performed within 36 hours post-transplant, and repeated at 24-48 hour intervals.
- Patients received triple therapy: low-dose prednisone, azathioprine, and cyclosporine A, with cyclosporine A initiated on postoperative day 2.
Main Results:
- Triple therapy, including delayed cyclosporine A administration, did not result in decreased renal blood flow in the early post-transplant period.
- This contrasts with findings from studies using high-dose, early-administered cyclosporine A as monotherapy.
Conclusions:
- A triple immunosuppression regimen with delayed initiation of cyclosporine A appears safe regarding early transplanted kidney perfusion.
- This protocol may mitigate the risk of cyclosporine-induced renal hypoperfusion in the immediate post-transplant phase.