DETRIMENTAL EFFECT OF CYCLOSPORINE ON INITIAL FUNCTION OF CADAVER RENAL ALLOGRAFTS FOLLOWING EXTENDED PRESERVATION Results of a randomized Prospective Study

Abstract

We report herein the resul6ts of a randomized prospective trial comparing maintenance cyclosporine (CsA)-p prednisone immunosuppression to a regiment of aazathioprine-prednisone-antilymphocyte globulin (ALG) in cadaver renal transplant recipients. Fifty-six patients were entered into this study with 31 assigned to the ALG group and 25 to the CsA group. These two groups were well matched for most major determinants of graft outcome and the mean renal preservation time was 37 hr in each group. The incidence of acute tubular necrosis (ATN) was high in both groups (58% ALG, 72% CsA, NS). There were five cases of primary nonfunction in the CsA group and only one in the ALG group (P=.05). Of the kidneys that functioned, the mean seum creatimine nadir (1.5 vs. 2.2 mg/dl, P=.03) were both loss in the ALG group. The actuarial one-year graft survival rate in the ALG and CsA groups is 78% and 48%, respectively (P<.05). This difference is mainly due to the large number of primary nonfunctioning grafts in the latter group, which we attribute to the effect of CsA's nephrotoxicity superimposed on renal ischemia incurred prior to transplantation. These data emphasize that, in order to realize the full benefit of csA in cadaver transplantation, renewed emphasis must be placed on minimizing ischemic renal damage.