Document Detail


Individualization of immediate posttransplant immunosuppression. The value of antilymphocyte globulin in patients with delayed graft function.
MedLine Citation:
PMID:  3278434     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In patients with delayed graft function (DGF), the use of cyclosporine (CsA) has been reported to prolong DGF, increase the number of required dialyses, increase the duration of hospitalization, and be associated with decreased graft survival. Routine postoperative antilymphocyte globulin (ALG) use has been advocated, but ALG is associated with increased viral infection. We studied outcome of individualization of immunosuppression. Between 11/84 and 8/86, first-cadaver transplant recipients whose serum creatinine (Cr) fell greater than or equal to 30% in the first 24 hr (immediate function) were started on CsA and prednisone (P) (group 1, n = 26). The remainder were randomized to P and azathioprine (group 2, n = 32) or P and ALG (group 3, n = 26), and switched to CsA when serum Cr fell greater than 30% (minimum 5 days ALG for the ALG group). P taper was the same in all groups. Patients with DGF (groups 2 and 3) had longer preservation time and higher peak PRA (P less than .05) than group 1. Groups were otherwise equivalent. One and 2-year patient survival was 96% (3 cardiovascular deaths; all with functioning grafts). One-year graft survival was 87% for group 1, 87% for group 2, and 82% for group 3(NS). In patients requiring dialysis, mean day off dialysis was 12 +/- 3 in both groups 2 and 3. Mean hospital stay was 12.5 +/- 1.3 days for group 1, 21.6 +/- 2.1 days for group 2 (P less than .05 vs. 1 & 3), and 14.5 +/- 1.2 days for group 3 (NS vs. 1). The increased hospital stay for group 2 patients was mainly due to increased in-hospital rejections: 75% for group 2, (P less than .05 vs. group 1 [35%], and group 3 [11.5%]). In addition, more group 2 in-hospital 1st rejections were steroid resistant as compared to group 1; 46% group 1 patients have remained rejection free as compared to 0% group 2 (P less than .05 vs. 1 and 3) and 35% of group 3 (P less than .05 vs. 1 and 2). Mean serum creatinine at 6-12 months remained higher in patients with DGF (group 1 P less than .05 vs. 2 and 3). Rejection was the major cause of graft loss in all groups.(ABSTRACT TRUNCATED AT 400 WORDS)
Authors:
A J Matas; V A Tellis; T A Quinn; D Glicklich; R Soberman; F J Veith
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Transplantation     Volume:  45     ISSN:  0041-1337     ISO Abbreviation:  Transplantation     Publication Date:  1988 Feb 
Date Detail:
Created Date:  1988-03-29     Completed Date:  1988-03-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  406-9     Citation Subset:  IM    
Affiliation:
Department of Surgery, Montefiore Medical Center, New York 10467.
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MeSH Terms
Descriptor/Qualifier:
Actuarial Analysis
Adolescent
Adult
Antilymphocyte Serum / analysis,  therapeutic use*
Creatinine / blood*
Cyclosporins / therapeutic use
Female
Graft Survival / drug effects
Humans
Kidney / physiopathology
Kidney Transplantation*
Length of Stay
Male
Middle Aged
Postoperative Period
Prednisone / therapeutic use
Chemical
Reg. No./Substance:
0/Antilymphocyte Serum; 0/Cyclosporins; 53-03-2/Prednisone; 60-27-5/Creatinine

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


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