Document Detail


Complications of cyclosporine-prednisone immunosuppression in 402 renal allograft recipients exclusively followed at a single center for from one to five years.
MedLine Citation:
PMID:  3544376     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The therapeutic efficacy of cyclosporine (CsA) as an immunosuppressive agent was complemented by a modest, long-term incidence of toxic complications in 402 renal allograft recipients engrafted one to five years prior to analysis. The overall patient and graft survivals at one year were 97% and 84% (actual), and at five years 92% and 67% (actuarial). The immunosuppressive therapeutic index was excellent: only 12% of allografts were lost from rejection, with 5% of patients succumbing to infection. While infections were common, tending to emanate in the urinary tract or to be viral in etiology, they were generally mild and readily controlled. Only four patients displayed malignancies; none succumbed to this cause. The most common toxic complication was hypertrichosis, which was accentuated in pediatric patients. While tremors occurred in 20% of patients, primarily during the first three months, other neuroectodermal complications of parethesias, depression, somnolence, and seizures were rare. Hepatotoxicity, which was noted in 50% of patients, particularly recipients of cadaveric grafts, generally was first seen as a transaminase elevation, at least partially reversible by dose-reduction and abating by the third year. Associated disturbances of cholelithiasis and pancreatitis were occasionally observed. Nephrotoxicity was the only persistent, long-term complication. Hypertension occurred in 72% of patients during the first month, 36% in the second year, and about 15% thereafter. Hyperuricemia, which occurred in about 30% of recipients during the first two years, was occasionally associated with symptomatic gout. The mean serum creatinine level remained elevated throughout the follow-up period at 1.8-1.9 mg/dl, suggesting persistent, but nonprogressive, drug-induced renal injury. The present analysis documents the relative safety of CsA for long-term therapy, and highlights the need for new approaches to ameliorate drug-induced nephrotoxicity.
Authors:
B D Kahan; S M Flechner; M I Lorber; D Golden; S Conley; C T Van Buren
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Transplantation     Volume:  43     ISSN:  0041-1337     ISO Abbreviation:  Transplantation     Publication Date:  1987 Feb 
Date Detail:
Created Date:  1987-03-26     Completed Date:  1987-03-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  197-204     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Azathioprine / therapeutic use
Child
Child, Preschool
Cyclosporins / adverse effects*,  therapeutic use
Follow-Up Studies
Graft Survival
Humans
Immunosuppression
Kidney / physiology,  physiopathology
Kidney Transplantation*
Liver / drug effects,  pathology
Middle Aged
Nervous System Diseases / chemically induced
Prednisone / adverse effects*,  therapeutic use
Transplantation, Homologous
Chemical
Reg. No./Substance:
0/Cyclosporins; 446-86-6/Azathioprine; 53-03-2/Prednisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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