Use of cyclosporin A after antilymphocyte serum in renal transplantation

: For the past 18 months, cyclosporin A has been used in our renal transplantation center, according to a randomized protocole in which the drug is introduced late (3rd month), following a standard treatment with prednisone, azathioprine and antilymphocyte serum, in a low dosage (4-6 mg/mg/day) and alone. This protocol has been designed to preserve the full benefits of the antilymphocyte serum given immediately after transplantation, to reduce the risk of cyclosporine nephrotoxicity and to allow the withdrawal of corticosteroids. When compared with 27 patients under standard treatment, the 31 patients who received cyclosporin A have an actuarial graft survival rate of 94% at 12 and 18 months, against 68% in the other group. At least one rejection episode was observed in 43% and 51% of patients under respectively cyclosporin A and standard treatment. Renal function remained stable after cyclosporin A was introduced and 1 year post-grafting mean serum creatinine values were similar in both groups. Acute and chronic nephrotoxicity has been the major complication of cyclosporin A. Excellent results (94% graft survival rate at 18 months) can be obtained using the sequential association of antilymphocyte serum and cyclosporin A, without the impairement in renal function that has been observed in other studies where cyclosporin A is given on the day of transplantation.