Cyclosporine in multi‐drug therapy in living‐related kidney transplantation

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Abstract
This report describes our experience with 146 living‐related kidney transplantations performed at our institution between January 1981 and December 1989. The results obtained in patients immunosuppressed with triple therapy consisting of azathioprine, prednisone, and cyclosporine are compared with those of patients treated with azathioprine and prednisone only. The effects of renal disease etiology (diabetic versus non‐diabetic) and HLA match on patient and graft survival are also evaluated. The addition of cyclosporine to azathioprine and prednisone had no significant effect on patient survival in any group. However, cyclosporine‐treated recipients showed increased graft survival in the overall (88% vs 73% at 5 years), diabetic (87% vs 75% at 5 yr) and non‐diabetic (93% vs 72% at 5 yr) groups when compared to similar groups treated with azathioprine and prednisone only. Recipients of HLA‐identical transplants achieved excellent results with double therapy (85% 5‐yr graft survival); addition of cyclosporine improved graft survival (93% at 5 yr), but this was not statistically significant. Similar findings were observed when the subgroups of diabetic and non‐diabetic HLA‐identical recipients were studied. In contrast, 5‐yr graft survival in HLA non‐identical recipients was significantly improved in those patients who received cyclosporine (85%) when compared to those who received only azathioprine and prednisone (64%). Improved graft survival was also observed when diabetic and non‐diabetic recipients of HLA‐mismatched grafts were studied separately. Immunosuppressive requirements, renal function and serum lipids of patients on double and triple therapy were compared. No differences in the amounts of prednisone and/or azathioprine required were noted in any group. Diabetics on cyclosporine were found to require higher daily cyclosporine doses, but nevertheless showed lower blood cyclosporine levels than non‐diabetics. Creatinine levels at 4 yr were slightly lower in cyclosporine‐treated patients (1.4 vs 1.8) as were serum lipids in both diabetic (cholesterol = 204 vs 274; triglycerides = 155 vs 229) and non‐diabetic (cholesterol = 219 vs 290; triglycerides = 202 vs 284) patients. In conclusion, we believe these results show that cyclosporine controls chronic rejection better than azathioprine and prednisone alone, does not produce significant chronic nephrotoxicity at 4 or 5 yr post‐transplant, and significantly improves graft survival in HLA‐mismatched living related transplantation.