STUDY OF 54 RENAL ALLOGRAFT RECIPIENTS IN THE CYCLOSPORIN A ERA: What Influences Acute Rejection Episode and Long-Term Graft Survival?

During the past 5-year period from 1986 to 1991, a total of 54 patients received living-related renal allograft and has been managed with vagaries of cyclosporin A (CYA) immunosuppressive regimen. In order to determine the ideal form of induction regimen, combination drugs with CYA, the initial dosage of CYA and its blood trough level were retrospectively analyzed with particular reference to the possible factors relevant to the occurrence of acute rejection episode in the first three post-transplant months and graft survival. The combination drugs with CYA were predonisolone (PRD) in 10 patients, PRD+azathioprine (AZA) in 19 and PRD+mizoribine (MIZ) in 25. The initial dosage of CYA was 6mg/kg B. W. in 6 patients, 8mg/kg in 17, 10mg/kg in 15 and ≥12mg/kg in 16. Blood trough level of CYA measured principally by high performance liquid chromatography was arbitrarily divided into 200mg/kg ranges for the analysis. By arbitrarily dividing the post-transplant period into four (period I: 0-15th day, period II: 16-30th, period III: 31-60th and period IV: 61-90th), the correlation of the incidence of acute rejection episode and aforementioned factors was studied. Relevance of these factors to the graft survival was also studied. The administration of AZA to MIZ to CYA+PRD had no suppressive effect upon the occurrence of acute rejection during the first three months and similarly it had no effect upon graft survival. Rejection episodes, however, occurred more frequently in the recipients with less than 150ng/ml of CYA trough level in the period I and less than 100ng/ml in the period III (p