Cyclosporin in renal transplantation: a 9 year experience

Review our 9 year experience using cyclosporin A (CyA) in a triple immunosuppressive regimen for renal transplantation.

Between 1 October 1984 and 30 June 1993 117 patients had a total of 130 renal transplants. This review was confined to 52 of these patients who had been on CyA for at least 12 months and had remained under regular surveillance in this clinic.

Patients were given 10 mg/kg of CyA prior to transplantation then 8 mg/kg/d in two divided doses after the onset of graft function. The maintenance dose was tapered to a mean of 3.5 mg/kg/d (SD 1.4) within 9 months and thereafter ranged from 3.0-3.4 mg/kg/d. Individual patients differed significantly in the trough whole blood CyA concentrations that they produced on a certain dose. Chronic CyA nephrotoxicity occurred in 3 patients and equivocal changes in another patient, while on a CyA dose of 3.0-4.0 mg/kg/d.

CyA was an effective drug as part of a triple immunosuppressive regimen for renal transplantation. Chronic CyA nephrotoxicity was an unpredictable finding and occurred with doses as low as 3.0-4.0 mg/kg/d and with drug concentrations within the recommended therapeutic range. All patients on CyA should be under regular supervision and early graft biopsy undertaken if there is evidence of graft dysfunction.