INDUCTION THERAPY WITH CYCLOSPORINE WITHOUT CYTOLYTIC AGENTS RESULTS IN A LOW INCIDENCE OF ACUTE REJECTION WITHOUT SIGNIFICANT RENAL IMPAIRMENT IN HEART-TRANSPLANT PATIENTS

Since 1989, the immunosuppressive regimen used in all heart transplant patients at our center has consisted of (i) cyclosporine induction th erapy (pretransplant p.o. 2-6 mg/kg depending on serum creatinine leve l, with immediate post-transplant i.v. therapy at 1-3 mg/h until p.o. therapy alone maintains a whole blood trough level of 300 ng/ml by RIA ); (ii) azathioprine (2.5 mg/kg/d i.v./p.o.); (iii) methylprednisolone i.v. for 24 h and then prednisone p.o. at 1 mg/kg/d, tapering to 0.1 mg/kg/d at 1 yr. No prophylactic cytolytic agents (ALG, OKT3) were giv en. One hundred consecutive patients have been followed for periods of 4-56 months (mean 27 months). The incidence of acute rejection requir ing increased therapy was 24%, with only 7% requiring i.v. steroids, 2 of whom (2%) also required ALG and/or OKT3, and with 17% requiring in creased oral immunosuppression alone. Mean creatinine levels (mg/dl) w ere 1.3 pretransplant, 1.4 on d 7, 1.5 at 30 d, and 1.8 after 2 yr. On ly 1 patient required temporary hemodialysis. Survival was 98% at 30 d , 94% at 1 yr, and 92% at 2 yr. We conclude that cyclosporine inductio n therapy with steroids and azathioprine without any cytolytic agent r esults in a low incidence of acute rejection without jeopardizing rena l function.