CYCLOSPORINE-A - EARLY OR DELAYED ONSET BY PROPHYLACTIC IMMUNOSUPPRESSION

In a prospective randomized trial, 57 renal transplant patients receiv ed sequential immunosuppression consisting of lymphocytoglobulin (ALG) , azathioprine, and steroids for 14 days (group A) and another 57 pati ents for only 2 days (group B). In each case therapy was continued wit h cyclosporin A and steroids. The purpose of this study was to find th e most favourable time to switch over to continuous cyclosporin A ther apy with avoidance of its nephrotoxic side-effects during the perioper ative phase. As a consequence of ALG intolerance, conventional immunos uppression had to be changed in group A after a mean of 7.8 days, as o pposed to 2.1 days in group B. The patients receiving a prophylactic t herapy with ALG, azathioprine, and steroids for 14 days (group A) had to be dialysed at a significantly greater frequency than patients with an early start to cyclosporin A (group B) from the second to the four th week. Patient survival rates 1 and 2 years after transplantation of group A (95 and 92%) and group B (96 and 92%) were not distinct. and there was no significant difference in graft survival rates of group A (79 and 79%) and B (89 and 82%) after the same time. A delayed start of cyclosporin A after 14 days showed no further advantage but rather a significantly greater frequency of dialysis; thus the early onset of cyclosporin A treatment post-transplant is preferable.