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AN INCREASED INCIDENCE OF LATE ACUTE REJECTION EPISODES IN CADAVER RENAL-ALLOGRAFT RECIPIENTS GIVEN AZATHIOPRINE, CYCLOSPORINE, AND PREDNISONE TRANSPLANTATION Wrenshall, L. E., Matas, A. J., Canafax, D. M., Min, D. I., Sibley, R. J., Dunn, D. L., Payne, W. D., Sutherland, D. E., Najarian, J. S. 1990; 50 (2): 233-237

Abstract

We studied the incidence of biopsy-proven, acute rejection episodes occurring after 1 year posttransplant in cadaver renal allograft recipients. The 328 patients evaluated were given three immunosuppressive drug protocols. Group I (transplanted 9/80-6/84) (n = 75) received azathioprine, prednisone (P), and antilymphoblast globulin; group II (transplanted 9/80-6/84) (n = 83) received cyclosporine and P; group III (transplanted 7/84-12/86) (n = 170) received ALG, AZA, CsA, and P (sequential therapy). The incidence of first acute rejection episodes occurring up to 1 year posttransplant was 55% in group I and 35% in groups II and III. The incidence of late (greater than 1 year) acute rejection episodes was 6.5% in group I, 2.5% in group II, and 9.5% in group III (group II vs. III, P = 0.02). In group III, 50% of the late rejections were first, 44% second, and 6% third. The primary etiologies of this increased incidence of late acute rejection may have included subtherapeutic CsA levels and lower P doses. Sequential immunosuppressive therapy has been shown to be advantageous in the first posttransplant year. However, unless adequate immunosuppression is maintained, this approach can be associated with a significantly increased incidence of late acute rejection.

View details for Web of Science ID A1990DU71400012

View details for PubMedID 2382291