In a randomized multicenter trial, 209 recipients of cadaveric renal transplants were treated either with cyclosporine and prednisone or with standard therapy that included azathioprine and prednisone. Predicted graft survival at one year was 80.4 per cent in patients receiving cyclosporine and 64.0 per cent in those receiving standard therapy (P = 0.003). Predicted patient survival at one year was 96.6 per cent in patients given cyclosporine and 86.4 per cent in those given standard therapy. A detrimental effect on predicted graft survival at one year was seen in patients treated with cyclosporine if they received kidneys that were perfused by machine for longer than 24 hours (70 vs. 88 per cent, P = 0.005) or if the time used to perform the surgical anastomosis was longer than 45 minutes (60 vs. 89 per cent, P = 0.002). In the group receiving standard therapy, predicted graft survival was better in patients who had had five or more blood transfusions than in those who had had two to four transfusions (77 vs. 55 per cent, P = 0.05). Serum creatinine was 2.6 mg per deciliter in patients receiving cyclosporine 90 days after transplantation and 2.0 mg per deciliter in those receiving standard therapy (P = 0.03). Lymphoma developed in one patient receiving cyclosporine. We conclude that cyclosporine is preferable to azathioprine in preventing renal transplant rejection. Further studies will be required to determine the optimal regimen with this agent.
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WAHN, F., DANIEL, V., KRONENBERG, F., OPELZ, G., MICHALK, D. V., QUERFELD, U.
(2001). Impact of Apolipoprotein(a) Phenotypes on Long-Term Renal Transplant Survival. J. Am. Soc. Nephrol.
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[Abstract][Full Text]
Hochleitner, B. W., Kafka, R., Spechtenhauser, B., Bosmuller, C., Steurer, W., Konigsrainer, A., Margreiter, R.
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[Abstract][Full Text]
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(2000). Recommendations for the Outpatient Surveillance of Renal Transplant Recipients. J. Am. Soc. Nephrol.
11
: S1-S86
[Abstract][Full Text]
Hausberg, M., Barenbrock, M., Hohage, H., Muller, S., Heidenreich, S., Rahn, K.-H.
(1999). ACE Inhibitor Versus ß-Blocker for the Treatment of Hypertension in Renal Allograft Recipients. Hypertension
33: 862-868
[Abstract][Full Text]
van der Schaaf, M. R., Hene, R. J., Floor, M., Blankestijn, P. J., Koomans, H. A.
(1995). Hypertension After Renal Transplantation : Calcium Channel or Converting Enzyme Blockade?. Hypertension
25: 77-81
[Abstract][Full Text]
Held, P. J., Kahan, B. D., Hunsicker, L. G., Liska, D., Wolfe, R. A., Port, F. K., Gaylin, D. S., Garcia, J. R., Agodoa, L., Krakauer, H.
(1994). The Impact of HLA Mismatches on the Survival of First Cadaveric Kidney Transplants. NEJM
331: 765-770
[Abstract][Full Text]
van der Heide, J. J. H., Bilo, H., Donker, J.M., Wilmink, J. M., Tegzess, A. M.
(1993). Effect of Dietary Fish Oil on Renal Function and Rejection in Cyclosporine-Treated Recipients of Renal Transplants. NEJM
329: 769-773
[Abstract][Full Text]
Deray, G., Benhmida, M., Le Hoang, P., Maksud, P., Aupetit, B., Baumelou, A., Jacobs, C.
(1992). Renal Function and Blood Pressure in Patients Receiving Long-Term, Low-Dose Cyclosporine Therapy for Idiopathic Autoimmune Uveitis. ANN INTERN MED
117: 578-583
[Abstract]
Brayman, K. L., Stephanian, E., Matas, A. J., Schmidt, W., Payne, W. D., Sutherland, D. E. R., Gores, P. F., Najarian, J. S., Dunn, D. L.
(1992). Analysis of Infectious Complications Occurring After Solid-Organ Transplantation. Arch Surg
127: 38-48
[Abstract]
Showstack, J., Katz, P., Amend, W., Salvatierra, O.
(1990). The Association of Cyclosporine With the 1-Year Costs of Cadaver-Donor Kidney Transplants. JAMA
264: 1818-1823
[Abstract]
Porter, G. A., Bennett, W. M., Sheps, S. G.
(1990). Cyclosporine-Associated Hypertension. Arch Intern Med
150: 280-283
[Abstract]
Brayman, K. L., Dafoe, D. C., Smythe, W. R., Barker, C. F., Perloff, L. J., Naji, A., Fox, I. J., Grossman, R. A., Jorkasky, D. K., Starr, S. E., Friedman, H. M., Plotkin, S. A.
(1988). Prophylaxis of Serious Cytomegalovirus Infection in Renal Transplant Candidates Using Live Human Cytomegalovirus Vaccine: Interim Results of a Randomized Controlled Trial. Arch Surg
123: 1502-1508
[Abstract]
Offner, G., Hoyer, P. F., Juppner, H., Krohn, H. P., Brodehl, J.
(1987). Somatic Growth After Kidney Transplantation: Beneficial Effect of Cyclosporine in Comparison With Conventional Immunosuppression. Arch Pediatr Adolesc Med
141: 541-546
[Abstract]
Council on Scientific Affairs,
(1987). Introduction to the Management of Immunosuppression. JAMA
257: 1781-1785
[Abstract]
Simon, D. G.
(1986). A Cost-effectiveness Analysis of Cyclosporine in Cadaveric Kidney Transplantation. Med Decis Making
6: 199-207
[Abstract]
Hesse, U. J., Fryd, D. S., Chatterjee, S. N., Simmons, R. L., Sutherland, D. E. R., Najarian, J. S.
(1986). Pulmonary Infections: The Minnesota Randomized Prospective Trial of Cyclosporine vs Azathioprine-Antilymphocyte Globulin for Immunosuppression in Renal Allograft Recipients. Arch Surg
121: 1056-1060
[Abstract]
Ryffel, B., Mihatsch, M. J.
(1986). Cyclosporine Nephrotoxicity. Toxicol Pathol
14: 73-82
[Abstract]
Ellis, D., Avner, E. D., Rosenthal, J. T., Taylor, R. J., Young, L. W., Palumbi, M. A., Hakala, T. R.
(1985). Renal Function and Somatic Growth in Pediatric Cadaveric Renal Transplantation With Cyclosporine-Prednisone Immunosuppression. Arch Pediatr Adolesc Med
139: 1161-1167
[Abstract]
Bantle, J. P., Nath, K. A., Sutherland, D. E. R., Najarian, J. S., Ferris, T. F.
(1985). Effects of Cyclosporine on the Renin-Angiotensin-Aldosterone System and Potassium Excretion in Renal Transplant Recipients. Arch Intern Med
145: 505-508
[Abstract]
Levey, A. S.
(1984). The Improving Prognosis After Kidney Transplantation: New Strategies to Overcome Immunologic Rejection. Arch Intern Med
144: 2382-2387
[Abstract]
COHEN, D. J., LOERTSCHER, R., RUBIN, M. F., TILNEY, N. L., CARPENTER, C. B., STROM, T. B.
(1984). Cyclosporine: A New Immunosuppressive Agent for Organ Transplantation. ANN INTERN MED
101: 667-682
[Abstract]
