Graft outcome in cadaver renal transplants treated with full-dose cyclosporine induction without antibody, irrespective of graft function

Abstract

Cyclosporine (CSA) induction has been shown to prolong delayed graft function which in turn may compromise graft outcome. In this study we report our experience with full-dose CSA induction without antibody treatment irrespective of graft function and stress the importance of achieving therapeutic CSA levels in the early post-transplant period. The records of 293 first cadaver renal transplant recipients who were transplanted between January 1992 and December 1995 were reviewed. Patients were divided into those who had immediate graft function (IGF, n = 197) and the ones who had delayed graft function (DGF, n = 96). Twenty-six (13%) patients in the IGF group and 27 (28%) patients in the DGF group experienced at least one episode of acute rejection (AR), (P = 0.002). Patient and graft survival rates at 1, 2 and 5 yr were similar in the IGF and DGF groups. Cox regression analysis revealed that the absence of both DGF and AR was independently associated with a 0.44 times lower risk of graft failure (P = 0.06), whereas AR without DGF was associated with a 1.9 times increased risk of graft failure (P = 0.02). DGF, with or without AR, did not affect the risk of graft failure. Logistic regression analysis showed that DGF was associated with a 3.6 times higher risk-of AR (P = 0.003). A non-traumatic cause of donor death and preservation time > 24 h were associated with 1.9 and 2.4 times higher risks of DGF (P = 0.01, P = 0.08), whereas female donor gender reduced the risk of DGF by 0.6 (P = 0.1). In conclusion, our results suggest that full-dose CSA induction with achievement of therapeutic target levels in the early post-transplant period is associated with an acceptable graft outcome. Graft outcome was not compromised by delayed function, whereas acute rejection was an independent predictor of graft failure.