ELECTIVE CYCLOSPORINE WITHDRAWAL 1 YEAR AFTER RENAL-TRANSPLANTATION

被引:46
作者
HEIMDUTHOY, KL
CHITWOOD, KK
TORTORICE, KL
MASSY, ZA
KASISKE, BL
机构
[1] UNIV MINNESOTA,COLL PHARM,MINNEAPOLIS,MN 55455
[2] UNIV MINNESOTA,SCH MED,MINNEAPOLIS,MN 55455
关键词
CYCLOSPORINE; WITHDRAWAL; RENAL TRANSPLANTATION;
D O I
10.1016/S0272-6386(12)80680-9
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Whether the risks of acute rejection after elective cyclosporine (CsA) withdrawal in renal transplantation outweigh the potential benefits is unclear. We examined results for 236 patients who underwent transplantation between January 1986 and June 1991. Patients were treated with prophylactic CsA, prednisone, and azathioprine, and had grafts that functioned at least 1 year. We elected to withdraw CsA after 1 year in 192 patients who were rejection free for 12 months. Thirty-four patients elected to continue CsA. In 1988 a protocol that tapered CsA over 6 weeks was abandoned when eight (29.6%) of the first 27 patients developed acute rejection within 6 months. We then adopted a 12-week CsA taper preceded by 1 month of increased azathioprine (2.5 mg/d as tolerated) and followed by increased prednisone (30 mg/d for 1 week, 20 mg/d for 1 week, 15 mg/day for 6 months, then 15 mg/d on alternate days). With this protocol the incidence of postwithdrawal acute rejection within 6 months was reduced to 9.1% among 165 patients (P < 0.01 v 6-week taper). Actuarial 5-year graft survival (patients living with a functioning graft) was 81.7% for patients left on CsA, 88.9% for patients tapered over 6 weeks, and 81.5% for patients tapered over 12 weeks (P > 0.05). We also examined risk factors for acute rejection after CsA withdrawal using a Cox proportional hazards model and found that the relative risk of acute rejection within 6 months of taper was approximately two times greater for each DR mismatch (P < 0.001). We conclude that CsA withdrawal has not affected renal allograft survival at our center. Moreover, the risk of acute rejection following CsA withdrawal was proportional to the number of DR mismatches, suggesting that an emphasis on major histocompatibility complex matching may reduce the need for long-term CsA. (C) 1994 by the National Kidney Foundation, Inc.
引用
收藏
页码:846 / 853
页数:8
相关论文
共 23 条
  • [1] OPTIMIZED HIGH-PERFORMANCE LIQUID-CHROMATOGRAPHIC METHOD FOR THE ANALYSIS OF CYCLOSPORINE AND 3 OF ITS METABOLITES IN BLOOD AND URINE
    AWNI, WM
    MALONEY, JA
    [J]. JOURNAL OF CHROMATOGRAPHY-BIOMEDICAL APPLICATIONS, 1988, 425 (01): : 233 - 236
  • [2] Bradley B A, 1989, Clin Transpl, P175
  • [3] BUSING M, 1989, TRANSPLANT P, V21, P1601
  • [4] COX DR, 1972, J R STAT SOC B, V34, P187
  • [5] DELMONICO FL, 1994, CLIN TRANSPLANT, V8, P34
  • [6] DIXON WJ, 1985, BMDP STATISTICAL SOF
  • [7] LONG-TERM OUTLOOK FOR RENAL-TRANSPLANT RECIPIENTS WITH ONE-YEAR FUNCTION - DOCTOR, WHAT ARE MY CHANCES
    FISCHEL, RJ
    PAYNE, WD
    GILLINGHAM, KJ
    DUNN, DL
    SUTHERLAND, DER
    MATAS, AJ
    NAJARIAN, JS
    [J]. TRANSPLANTATION, 1991, 51 (01) : 118 - 122
  • [8] COMPARISON OF 3 IMMUNOSUPPRESSIVE REGIMENS IN CADAVER RENAL-TRANSPLANTATION - LONG-TERM CYCLOSPORINE, SHORT-TERM CYCLOSPORINE FOLLOWED BY AZATHIOPRINE AND PREDNISOLONE, AND AZATHIOPRINE AND PREDNISOLONE WITHOUT CYCLOSPORINE
    HALL, BM
    TILLER, DJ
    HARDIE, I
    MAHONY, J
    MATHEW, T
    THATCHER, G
    MIACH, P
    THOMSON, N
    SHEIL, AGR
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1988, 318 (23) : 1499 - 1507
  • [9] HIESSE C, 1991, TRANSPLANT P, V23, P987