[The effect of cyclosporin on renal function following cardiac transplantation: should one lessen the toxicity?].

Between 1983 and 1988, 50 patients underwent cardiac transplantation at the Institut de Cardiologie de Montréal. During this period, four immunosuppression protocols were used, each including cyclosporine. A combination of cyclosporine and prednisone was used in the first 24 patients (group 1). Triple combination immunosuppression (cyclosporine, prednisone and azathioprine) was given perioperatively in 13 patients (group 2). The prophylactic use of rabbit antithymocyte globulin and late administration (4 days postoperatively) of cyclosporine to prevent early renal failure associated with cyclosporine therapy was chosen in 13 other patients (group 3). Owing to serious deterioration of renal function in 15 of the 24 group 1 patients, the serum creatinine levels reaching 255 +/- 51 mmol/L and the creatinine clearance 34 +/- 2 ml/min between 6 months and 4 years after transplantation, immunosuppression was modified to triple-combination therapy by the addition of azathioprine and a reduction of the serum levels of cyclosporine (group 4). Twelve of the 15 patients showed a substantial improvement in renal function from 3 to 18 months after these changes were introduced. No patient in groups 2 and 3 had late renal insufficiency, and in all group 3 patients renal function remained normal as in the immediate postoperative period. In conclusion, important modifications in protocol permitted a reduction of early and late renal failure due to cyclosporine after cardiac transplantation.