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

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

Techniques for combined procurement of hearts and kidneys with satisfactory early function of renal allografts.

Methods for combination of donor nephrectomy with donor cardiectomy are outlined. The satisfactory early function of 29 of 34 transplanted kidneys harvested with these techniques supports their wider application and should encourage their wider acceptance