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The authors report their experience using cyclosporine-A (CsA) in renal transplant patients. When compared with azathioprine/prednisone, CsA contributed significantly to a better graft and patient survival, either if used associated with prednisone of with azathioprine plus prednisone. CsA was also used in substitution to azathioprine in patients with hepatopathy attributed to azathioprine toxicity. The initial results are promising. The association of CsA and azathioprine with corticosteroids withdrawal was used as an attempt to allow normal growth in children. This seems to be the best choice of treatment for children. Careful monitoring of CsA blood levels avoids, or at least, minimizes nephrotoxicity. To achieve therapeutic CsA levels, patients with liver damage need lower, while children need higher oral CsA doses. To summarise: when CsA in carefully used, it is an excellent immunosuppressive drug.

From 1969 to 1987, 35 pregnancies occurred in 31 women with renal transplant. Four of them were still pregnant when this study was concluded. There was one ectopic pregnancy. All patients received azathioprine and prednisone. In the majority of patients the glomerular filtration rate increased in a way similar to normal pregnant women. In five cases there was a progressive loss in renal function. In four of them this was attributed to preexistent renal damage. No toxemia occurred. Anemia developed during 11 pregnancies and blood transfusion was required for five women. Four patients had urinary tract infection which was easily controlled with antibiotics. One patient had severe arterial hypertension, secondary to chronic rejection. One patient developed jaundice reverted with reduction in azathioprine doses. One woman died of septicemia secondary to fetal death, during the 6th month of pregnancy. Twenty children were born with no abnormalities, although many of them were underweighted. Two thirds of pregnancies were delivered by cesarean section. No harm to the pelvic allograft occurred in vaginal deliveries. There have been 4 abortions (2 of them were induced with no medical indication). Four pregnancies (26 to 39 gestational weeks) ended in stillborn babies: the mothers had impaired renal function associated with hypertension and proteinuria. One newborn died of pulmonary infection two days after delivery. Another was born with microcephaly and polydactilia and survived 6 years. No breast feeding was allowed.

The course of 16 patients with segmental and focal glomerulosclerosis (SFGS) with kidney transplantation is reported. Ten out of 16 (group I) had the diagnosis histologically confirmed in their native kidneys. In 6 (group II) the diagnosis was suggested by the early development of SFGS in the graft and was considered a recurrence of the baseline disease. The recurrence (in group I) was 40% and the main clinical parameter was proteinuria, in nephrotic level, with early development in all cases (less than 60 days). In those patients who had an early development of the baseline disease (less than 4 years) the recurrence was greater, observed in 5 out of 8 grafts with 3 grafts lost due to the recurrence of focal glomerulosclerosis. On the other hand, the patients whose baseline disease had a longer period of development presented a better course of the recurrent glomerulosclerosis and no grafts were lost in this cases. We believe that renal transplantation of a live donor must be avoided in those patients with quick developing SFGS.