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Cyclosporine-treated kidney transplants from living-related donors--a single center trial
1Department of Surgery, Tokyo Women's Medical College, Japan.
Insights
Cyclosporine A (CsA) improved 5-year kidney transplant survival compared to Azathioprine (AZ), but higher creatinine levels warrant further study. Donor-specific transfusion (DST) may benefit CsA-treated recipients, especially with poor tissue matching.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Cyclosporine A (CsA) is a key immunosuppressant in kidney transplantation.
- Optimizing CsA regimens is crucial for long-term graft survival and renal function.
- Living-related donor kidney transplantation outcomes require continuous evaluation.
Purpose of the Study:
- To compare the efficacy of Cyclosporine A (CsA) versus Azathioprine (AZ) in living-related donor kidney transplant recipients.
- To investigate the impact of donor-specific transfusion (DST) and crossmatch results on graft survival in CsA-treated patients.
- To analyze rejection patterns based on antibody profiles.
Main Methods:
- Retrospective analysis of 369 CsA-treated recipients and 160 AZ-treated controls.
- Donor-specific transfusion (DST) performed in recipients responding to mixed lymphocyte reaction (MLR).
- Evaluation of graft survival rates based on crossmatch status and antibody profiles.
Main Results:
- Five-year graft survival was 78.2% with CsA versus 58.5% with AZ. CsA recipients had higher serum creatinine levels.
- No significant difference in outcomes between DST and non-DST groups in CsA-treated recipients, suggesting DST benefit.
- Lower graft survival in patients with transient positive crossmatch.
- Acute rejection highest in T-cell antibody positive cases; chronic rejection highest in cold B-cell positive cases.
- Azathioprine (AZ) combined with local graft irradiation suppressed blood group antigen antibodies.
Conclusions:
- CsA offers superior graft survival but necessitates careful monitoring of renal function.
- DST may be beneficial in CsA-treated recipients, particularly with suboptimal tissue matching.
- Crossmatch status and specific antibody profiles influence rejection risk and graft outcomes.
- Further research is needed to optimize CsA administration for long-term renal function maintenance.
Abstract:
Analysis of 369 CsA-treated recipients transplanted with living-related donor grafts was presented along with the results of a control group of 160 recipients treated with AZ. 1. The 5-year graft survival was 78.2% in the CsA group as opposed to 58.5% in the control group. However, serum creatinine levels in the CsA group were higher than those in the CT group. 2. DST was carried out in recipients showing response to MLR. The fact that no significant difference was found between the DST and non-DST groups despite the poor tissue matching, may favor the effect of DST in CsA-treated recipients. 3. The graft survival rate in patients with a transient positive crossmatch was lower than that obtained in patients with no history of a positive crossmatch. 4. Incidence of acute rejection was highest in T-cell antibody positive cases, while the incidence of chronic rejection was highest in cold B-cell positive cases. 5. The combined use of AZ and local graft irradiation successfully suppressed the formation of antibodies to blood group antigens. 6. Detailed analysis and follow-up studies will be necessary to establish the optimum regimen of CsA administration for the long-term maintenance of renal function in CsA-treated recipients.