Two decades of experience with cyclosporine in renal transplantation in Helsinki.

We present our experience on cyclosporine (CsA) triple immunosuppression in 2445 cadaveric kidney transplantations performed from 1984 to 2002 in Helsinki. Overall, delayed onset of graft function occurred in 30.2% and acute rejection in 25.6% of the transplantations. The 1-, 5-, and 10-year patient survival was 95.1%, 84.5%, and 69.1%; the graft survival rates were 90.0%, 74.9%, and 56.7%; and the death-censored graft survival, 93.3%, 83.5%, and 72.4%. During the study period, the 5-year patient survival improved from 70.8% to 90.6% and the graft survival from 58.2% to 88.0% with the graft half-life estimate of 1-year survivors improving from 7.6 to 21.8 years. Acute rejection episodes decreased from 33.0% to 19.9% and the calculated creatinine clearance at 1 year improved from 50.3 mL/min to 74.3 mL/min. Mean CsA dose diminished significantly, both at 3 weeks (from 8.2 mg/kg to 4.9 mg/kg) and at 1 year posttransplant (from 3.7 mg/kg to 2.8 mg/kg). In 16.7% of transplantations where azathioprine had to be discontinued early, significantly more rejections occurred (38.0% vs 23.2%) with inferior 1-year graft survival (80.2% vs 94.8%) compared to the transplantations continuing on triple therapy. Among 1-year survivors, the 6-month serum creatinine level was strongly associated with death-censored long-term graft survival. In this material, the CsA dosage at 1 year did not predict long-term graft survival.