Acute renal failure after heart transplantation and cyclosporine therapy

Five of 23 (22%) patients receiving cyclosporine immunosuppression following heart transplantation developed postoperative acute renal failure, whereas none of 17 patients treated with azathioprine had this complication (p = 0.05). Two pre-operative risk factors for acute renal failure in cyclosporine treated patients were identified: a serum creatinine greater than 2 mg/100 mL during the year prior to the transplantation and a need for inotropic support in the week prior to operation. A protocol of low dose cyclosporine and rabbit antithymocyte globulin was developed for patients with risk factors for acute renal failure. Among patients with one or both risk factors, five of nine receiving cyclosporine developed acute renal failure (56%) whereas of seven patients receiving the cyclosporine and rabbit antithymocyte globulin protocol, none developed acute renal failure (p = 0.02). The reduction in acute renal failure, using the cyclosporine/rabbit antithymocyte globulin protocol has been accomplished without an increase in early rejection or infection.