Nephrology, Dialysis and Transplantation
In order to avoid acute and chronic nephrotoxicity, 100 cadaveric transplants have been treated with oral cyclosporin starting at a dose of 10 mg/kg per day (one half dose every 12 h), immediately afterwards adjusted to reach a blood trough level of 200-400 ng/ml (RIA). Methylprednisolone, 16 mg/day, was also given for 90 days, then tapered to 8 mg/day or less. The cyclosporin mean dose was 4.6+1.03 mg/kg on the 90th day; 4.2 ± 1.2 mg at 6 months; 3.7 ± 1.3 mg at 1 year, and 3.6 ± 1.0 at 2
... 3.6 ± 1.0 at 2 years. Two-year actuarial graft survival was 92% in comparison to 60% in our historical control group receiving azathioprine and methylprednisolone at higher dose plus prophylactic ALG. On the average 2.4 methylprednisolone pulses/pt, 500 mg each, were given within the first 3 months for acute rejection episodes. One only graft was lost because of acute irreversible rejection. At 2 years the plasma creatinine was 1.48 + 0.57 vs 1.9 ±0.42 in our conventional series. Conversion from cyclosporin to azathioprine was never needed. Only non-invasive techniques were used to watch the graft status. In our experience low-dose cyclosporin was effective and safe: unmasked acute rejection crises were early diagnosed on a clinical basis and successfully treated; neither use of ALG (or monoclonal antibodies) nor switch to azathioprine (or tritherapeutic regimen) were requested. The lack of renal biopsy or FNAB did not affect the graft outcome.