Low-dose cyclosporine therapy in triple-drug immunosuppression for heart transplant recipients

Ann Thorac Surg. 1994 Oct;58(4):999-1004. doi: 10.1016/0003-4975(94)90444-8.

Abstract

The toxicity of long-term immunosuppressive therapy has become a major concern in long-term follow-up of heart transplant recipients. In this respect the quality of renal function is undoubtedly linked to cyclosporin A (CsA) drug levels. In cardiac transplantation, specific CsA trough levels have historically been maintained between 250 and 350 micrograms/L in many centers without direct evidence for the necessity of such high levels while using triple-drug immunosuppression. This retrospective analysis compares the incidence of acute and chronic graft rejection as well as overall mortality between groups of patients with high (250 to 350 micrograms/L) and low (150 to 250 micrograms/L) specific CsA trough levels. A total of 332 patients who underwent heart transplantation between October 1985 and October 1992 with a minimum follow-up of 30 days were included in this study (46 women and 276 men; aged, 44 +/- 12 years; mean follow-up, 1,122 +/- 777 days). Standard triple-drug immunosuppression included first-year specific CsA target trough levels of 250 to 300 micrograms/L. Patients were grouped according to their average creatinine level in the first postoperative year (group I, < 130 mumol/L, n = 234; group II, > or = 130 mumol/L, n = 98). The overall 5-year survival excluding the early 30-day mortality was 92% (group I, 216/232) and 91% (group II, 89/98) with 75% of the mortality due to chronic rejection. The rate of rejection for the entire follow-up period was similar in both groups (first year: group I, 3.2 +/- 2.6 rejection/patient/year; group II, 3.6 +/- 2.7 rejection/patient/year; p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Azathioprine / therapeutic use
  • Contraindications
  • Cyclosporine / blood
  • Cyclosporine / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Graft Rejection / complications
  • Graft Rejection / mortality
  • Graft Rejection / prevention & control*
  • Heart Transplantation / immunology*
  • Heart Transplantation / mortality
  • Humans
  • Immunosuppression / adverse effects
  • Kidney Function Tests
  • Male
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Renal Insufficiency / complications
  • Retrospective Studies
  • Survival Rate

Substances

  • Cyclosporine
  • Azathioprine
  • Methylprednisolone