Ten years of cyclosporine use in renal transplantation: a single-center experience with 479 renal transplants

Abstract

Introduction: From 1983 to 1996 therapy with cyclosporine in association with low-dose azathioprine and prednisone has been used for transplantation immunosuppression. The aim of our study was to present 10 years experience with cyclosporine.

Material and method: Among 479 renal transplants performed since 1992, 61 were performed with cadaver donor grafts and 58 in pediatric recipients. From 1992 to 1998, the immunosuppressive protocol included CsA, azathioprine, and prednisone. Since 1998, mycophenolate mofetil (MMF) replaced azathioprine. In 2002, tacrolimus and rapamycin were introduced into our protocols. The patients were assessed in terms of serum creatinine, incidence of acute rejection, cyclosporine side effects, and graft and patient survivals.

Results: Five-year patient and graft survivals were higher among recipients receiving CsA-MMF-prednisone when compared with CsA-azathioprine-prednisone. The incidence of acute rejection episodes during the first year after transplantation was less frequent among recipients receiving MMF compared to those treated with azathioprine. The overall 5-year survivals for patients was 86.29% and for grafts 74.04%.

Conclusion: Cyclosporine remains a useful immunosuppressive drug, which represents a major step toward efficient renal transplantation. The availability of multiple effective immunosuppressive agents allows individualized protocols to reduce toxic effects. The advent of new induction regimens offers more opportunities to prolong graft life.