Beneficial effect of concomitant induction with antilymphoblast globulin, cyclosporine, and steroids on long-term renal allograft outcome.

The addition of induction therapy with antilymphocytic antibodies to cyclosporine (CsA) based immunosuppression, has reduced acute rejection incidence and improved short-term survivals, but has not had well-established effects on long-term renal transplant survival. We analyzed the long-term allograft outcome of patients included in a prospective randomized clinical study conducted in our center 15 years ago by comparing two strategies: (A) horse antilymphoblast globulin (ALG) given at 10 mg/kg on alternate days to a maximum of 6 doses with low-dose CsA started at 8 mg/kg per day and prednisone at 0.25 mg/kg per day, versus (B) CsA started at 15 mg/kg per day and prednisone at 0.5 mg/kg per day. Diabetic and highly sensitized patients (PRA > 70%) were excluded from the study. The characteristics of the 50 patients enrolled in each group were not different. Although patient survival was not different (88% in group A vs 77% in group B), recipients treated with ALG showed a lower incidence of acute rejection episodes (20% vs 44%, P = .01) and better death-censored renal allograft survival (57% vs 41%, P = .03). Among rejection-free patients, graft survival was 15% higher in group A (60% vs 45%, P = .12). Multivariate Cox regression analysis showed that an acute rejection episode (relative risk [RR]: 2.44, 95% confidence interval [CI] 1.36-4.39; P = .0029) rather than ALG immunosuppression (RR 0.74, 95% CI 0.41-1.33; P = NS) was an independent predictor of death-censored graft survival. In summary, we confirmed that concomitant induction therapy with ALG, CsA, and steroids improves long-term renal allograft survival.

Koga A ，Moreso FJ ，Seron D ，Gil-Vernet S ，Cruzado JM ，Castelao AM ，Grinyó JM ... -  《TRANSPLANTATION PROCEEDINGS》

20-year follow-up results of a randomized controlled trial comparing antilymphocyte globulin induction to no induction in renal transplant patients.

Cantarovich M ，Durrbach A ，Hiesse C ，Ladouceur M ，Benoit G ，Charpentier B ... -  《-》

Detrimental effects of cyclosporin A on long-term graft survival in familial Mediterranean fever renal allograft recipients: experience of two transplantation centers.

Shabtai M ，Ben-Haim M ，Zemer D ，Malinger-Saavedra P ，Rosin D ，Kuriansky J ，Lustig S ，Shabtai EL ，Shapira Z ，Ayalon A ... -  《ISRAEL MEDICAL ASSOCIATION JOURNAL》

Long-term results of a prospective randomized study comparing two immunosuppressive regimens, one with and one without CsA, in low-risk renal transplant recipients.

Grimbert P ，Baron C ，Fruchaud G ，Hemery F ，Desvaux D ，Buisson C ，Chopin D ，Dahmane D ，Remy P ，Pastural M ，Abbou C ，Weil B ，Lang P ... -  《TRANSPLANT INTERNATIONAL》

Effect of early cyclosporine levels on kidney allograft rejection.

Johnson EM ，Canafax DM ，Gillingham KJ ，Humar A ，Pandian K ，Kerr SR ，Najarian JS ，Matas AJ ... -  《CLINICAL TRANSPLANTATION》