Nephrology Dialysis Transplantation, Vol 12, Issue 9 1956-1960, Copyright © 1997 by Oxford University Press
G Touchard, T Hauet, F Van Weydevelt, B de Ligny, P Peyronnet, Y Lebranchu, O Toupance P N'Doye and M Busson
Background. There is considerable debate about whether
maintenance cyclosporin (CsA) monotherapy is advisable or not in renal
transplantation. Methods. Between August 1984 and
December 1989, 463 adult patients received a first cadaver graft. Initial
immunosuppression was sequential: antilymphocyte or antithymocyte globulins
(10-14 days), prednisone and azathioprine were combined and CsA was
introduced (6-8 mg/kg/day) when the antilymphocyte or antithymocyte
globulins were discontinued. When the graft function was stable and the
peak of preformed lymphocytotoxic antibodies was &les:25% and/or the
number of rejection episodes was ⩽1, the steroid therapy was
stopped within 1.5-3 months after transplantation, and azathioprine within
3-12 months. Patients with both anti HLA antibodies >25% and more
than one rejection episode were excluded. Cyclosporin doses were adapted
for whole-blood trough levels between 100 and 200 ng/ml (monoclonal
antibody radioimmunoassay or high-performance liquid chromatography).
Cyclosporin monotherapy was attempted in 234 of the 463 patients.
Results. At the end of the investigation in January
1993 (follow-up time >36 months, mean 60.5±4.5 months),
135 patients were receiving CsA without steroids or azathioprine. The 99
CsA monotherapy failures were due to rejection episodes in 48 cases, CsA A
nephrotoxicity in 26 cases, and other causes in 25 cases, including five
deaths and four with poor compliance. Renal function was stable in patients
with successful CsA monotherapy: mean creatininaemia was 124±10
&mgr;mol/l at the time of CsA monotherapy inclusion and
129±10 &mgr;mol/l at the end of follow-up (mean time of CsA
monotherapy 52±6 months). The parameters for predicting
monotherapy success were age (43.2 versus 27.8,
P=0.0014), timing of trial inclusion ⩾6 months post-transplant
(7.9&;plusmn; versus 5.3&;plusmn;3.1 months,
P=0.04), and excellent and stable renal function at the time of inclusion
(124±10 versus 145±32
&mgr;mol/l, P<0.001). Conclusions.
Maintenance CsA monotherapy was effective in 58% of low-immunological-risk
first-graft patients and probably did not jeopardize overall results of our
first grafts: patient and graft survival were respectively 90 and 73% at 6
years. We propose this policy to avoid long-term complications of
glucocorticoid and azathioprine in selected compliant recipients with low
immunological risk, follow-up time post-transplantation >6 months,
and stable creatinaemia levels. Keywords: CsA
monotherapy; CsA toxicity; immunosuppression; long-term outcome; low
immunological risk
ORIGINAL ARTICLES
Maintenance cyclosporin monotherapy after renal transplantation-clinical predictors of long-term outcome
Departments of Nephrology, University Hospitals of Poitierrs, Angers, Caen, Limoges, Tours, Reims, and INSERM U93, France; Corresponding author at: Department of Nephrology, CHU, BP 577, F86021 Poitiers, France
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