IMPROVEMENT IN THE OUTCOME OF REJECTION WITH PENTOXIFYLLINE IN RENAL-TRANSPLANTATION - A RANDOMIZED CONTROLLED TRIAL

Background, Pentoxifylline (PTX), a methylxantine phosphodiesterase in hibitor commonly used to treat peripheral vascular disease, has been s hown to decrease the production of proinflammatory cytokines and react ive oxygen species and to reduce the toxic effects of cyclosporine. Th us, administration of PTX to transplant patients, as an adjunct to imm unosuppresive therapy, could prevent numerous posttransplantation comp lications. Methods, One hundred forty consecutive patients receiving c adaveric kidney grafts were registered in a randomized double-blind st udy comparing PTX at a dose of 800 mg/day, then 1200 mg/day, versus pl acebo during the first 6 months after transplantation. All patients we re followed up for 1 year, Results, Rejection episodes were validated as the only independent risk factor for graft loss in this study, We c ompared graft survival rates in each group according to the presence o r absence of acute rejection, Acute rejection reduced graft survival i n the control group (graft survival rate at 1 year, 59% vs. 97%, P<0.0 01), but this adverse effect was blunted in the PTX group (72% vs. 89% , NS), This improvement was confirmed by multivariate analysis for ris k. factors, with graft survival rates being described at best as the i nteraction between rejection and treatment (PTX vs, placebo, P=0.045), Conclusion, Although PTX does not modify the incidence of any posttra nsplant complications, it weakens the consequences of rejection on gra ft survival.