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A prospective randomized trial of pretransfusion/azathioprine/prednisone versus cyclosporine/prednisone immunosuppression in cardiac transplant recipients: preliminary results.
- Source :
-
Circulation [Circulation] 1985 Sep; Vol. 72 (3 Pt 2), pp. II227-30. - Publication Year :
- 1985
-
Abstract
- Cyclosporine has gained acceptance as the immunosuppressive agent of choice in cardiac transplantation, but the validity of this assumption has yet to be established. Since January 1983, 25 patients have been randomly assigned to receive either conventional immunosuppression (azathioprine/antithymocyte globulin/prednisone) and pretransplant transfusion (PAAP, n = 11) or cyclosporine immunosuppression (cyclosporine and prednisone [CyA], n = 14). There was no difference in the age distribution (41 +/- 9 vs 38 +/- 11 years), indications for transplantation, preoperative serum creatinine level (1.2 +/- 0.2 vs 1.4 +/- 0.3 mg/dl), or postoperative follow-up time (13.5 +/- 5.4 vs 13.5 +/- 5.2 months). Mortality was not different (PAAP = 2, CyA = 3) and there was no difference in rejection episodes per patient (PAAP = 1.8, CyA = 1.9). Patients in the PAAP group had more serious infections (PAAP = 8, CyA = 3; P less than .02), but those in the CyA group developed a greater incidence of systemic hypertension (PAAP = 1, CyA = 10; p less than .02), pericardial effusion (PAAP = 0, CyA = 6; p = .05), and impaired renal function (creatinine 1.5 mg/dl, PAAP = 2, CyA = 11; p less than .02). Thus it appears that in this small series, cyclosporine is not associated with a significant increase in early survival. It does appear that patients on PAAP immunosuppression develop a greater number of serious infections, but the incidence of rejection episodes appears to be the same. Renal dysfunction and hypertension in patients receiving cyclosporine continue to be long-term concerns and may add to the morbidity and mortality of patients treated with this immunosuppressive regimen.
- Subjects :
- Adult
Antilymphocyte Serum administration & dosage
Azathioprine adverse effects
Clinical Trials as Topic
Cyclosporins adverse effects
Drug Therapy, Combination
Female
Graft Rejection drug effects
Humans
Hypertension etiology
Infections etiology
Kidney physiopathology
Male
Middle Aged
Pericardial Effusion etiology
Prednisone adverse effects
Prospective Studies
Random Allocation
Heart Transplantation
Immunosuppressive Agents adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 0009-7322
- Volume :
- 72
- Issue :
- 3 Pt 2
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 3896555