Steps in immunosuppression for renal transplantation

The authors provide a historical survey of the immunosuppressive agents that have been used to prevent allograft rejection. Attention is given to the expected effect of cyclosporin in kidney translations

Cadaveric renal transplantation under cyclosporine-steroid therapy

Ninety-seven cadaveric renal transplants were performed upon 96 patients during 1981. The one year patient mortality was 2.1 per cent. Seventy of the recipients were undergoing trasplantation for the first time. Of these patients, 38 were treated with cyclosporine and steroids with a one year graft survival rate of 89.5 per cent. The other 32 primary recipients were treated with azathioprine and steroids with a one year graft survival rate of 50 per cent. The difference between the cyclosporine-steroid versus conventional therapy groups was significant. Cyclosporine and steroids were also used to treat 26 patients who underwent retransplantation with 27 cadaveric grafts. The one year graft survival time was 77.8 per cent; most of the graft losses were in presensitized patients. The results with retransplantation were twice as good as in historical control groups

Variable convalescence and therapy after cadaveric renal transplantation under cyclosporin A and steroids

The postoperative convalescence period was analyzed for 42 consecutive patients who had cadaveric renal transplantation under therapy with cyclosporin A and steroids. Twenty-two of the patients underwent transplantation for the first time, and the other 20 had retransplantation. None of the recipients has died. With follow-up period of two to eight months, the survival rate of grafts is 96 per cent after first transplantation and 85 per cent after retransplantation. Immunosuppression with a standard regimen was used for all patients at the outset. Early convalescence was highly variable, often necessitating adjustments of cyclosporin A and steroid dosage to accommodate the possibilities of rejection or cyclosporin A nephrotoxicity, or both, simultaneously. Management problems were more frequent and complex in patients undergoing retransplantation. From the results, a classification of convalescence patterns was evolved, with recommendations about how standardized initial therapy should be adjusted if the renal graft does not function promptly or deteriorates later

Nonobstructing Colonic Dilatation and Colon Perforations Following Renal Transplantation

Nonobstructing colonic dilatation has not been commonly reported following renal transplantation, and colon perforations carry a high morbidity and mortality in this population. During a 7-year period, nonobstructing colonic dilatation developed in 13 adults 1 to 13 days after renal transplantation. Twelve (92%) of the 13 had poorly functioning allografts. Five (83%) of the 6 with and 2 (29%) of the 7 without colonoscopy had resolution of nonobstructing colonic dilatation. Of the seven right-sided colon perforations during this period, six were associated with nonobstructing colonic dilatation. An additional 4 patients had diverticular perforations in the left colon. Of a total of 11 patients with colon perforation, 7 had surgery within 24 hours of the perforation and 6 (86%) of these survived. Only 1 (25%) of the 4 having surgery more than 24 hours later survived. Six of the survivors retained functioning allografts. Nonobstructing colonic dilatation seems to be a potential complication of poor graft function after renal transplantation, and colonoscopy is effective in its treatment. In patients with colon perforations, early surgery and reduced immunosuppression are essential in decreasing mortality. © 1990, American Medical Association. All rights reserved

Obesity as a risk factor following cadaveric renal transplantation

Obesity has generally been thought to increase the risk of operative mortality and postoperative complications in surgical patients. No data examining obesity as a factor in cadaveric renal transplantation were available. We therefore matched obese patients undergoing cadaveric renal transplantation with nonobese control patients and retrospectively analyzed mortality, morbidity, and graft survival in each group. Patients were matched for age, sex, diabetes mellitus, PRA, graft number, cardiovascular disease, date of transplantation, and posttransplant immunosuppression. There were significant differences found in mortality (11% in obese vs. 2% in nonobese patients, P<0.01), immediate graft function (38% in obese vs. 64% in nonobese patients, P<0.01), 1-year graft survival (66% in obese vs. 84% in nonobese patients, P<0.05), and postoperative complications. Wound complications (20% vs. 2%, P<0.01), intensive-care-unit admissions (10% vs. 2%, P<0.01), reintubations (16% vs. 2%, P<0.03), and new-onset diabetes (12% vs. 0%, P<0.02) were all significantly more common in the obese group. These results suggest that an attempt at significant weight reduction is indicated in obese patients prior to renal transplantation. © 1990 by Williams & Wilkins

Cadaveric renal transplantation with cyclosporin-A and steroids

Cyclosporin A and steroid was compared to Imuran and prednisone in a prospective, randomized study of patients undergoing primary cadaver renal transplantation. Graft survival was superior in the cyclosporin-A-treated group, with 1-year kidney function of 92% and less infections. No kidneys were lost to rejection in this group. Further experience with a variety of high-risk patients have reinforced this early experience, showing few kidneys lost to rejection and low incidence of infectious complications using cyclosporin-A and low dose steroid combination