Thomsen H S, Nielsen S L, Larsen S, Løkkegaard H
Eur J Nucl Med. 1987;12(10):473-6. doi: 10.1007/BF00620467.
Acute impairment of renal function caused by cyclosporin A can be hard to differentiate from acute rejection. Therefore, kidney function after cadaveric allograft transplantation was repeatedly determined by renography in 42 patients receiving either high dose cyclosporin A (32 patients) or azathioprine and prednisone (10 patients) until a graft biopsy showed either acute rejection or no rejection within the first 5 postoperative weeks. The graft function as judged from the renograms was significantly poorer when cyclosporin A was used than when azathioprine and prednisone were the immunosuppressants. In the azathioprine and prednisone group a biopsy showing acute rejection was always preceded by a deterioration in the renogram. In cyclosporin A treated patients a graft biopsy following an early deterioration in the renogram showed acute rejection in only 56% of the biopsies. It was not possible to identify a time course or a function level of the renogram that could predict rejection in these patients. It is concluded that graft biopsies should be used liberally to diagnose rejection during cyclosporin A treatment if surgical complications after transplantation have been ruled out. Radionuclide studies may offer an invaluable aid in determining a nonnephrotoxic initial dose of the drug.
环孢素A引起的急性肾功能损害可能难以与急性排斥反应区分开来。因此，对42例接受大剂量环孢素A（32例）或硫唑嘌呤及泼尼松（10例）的尸体同种异体肾移植患者，在术后前5周内，通过肾图反复测定肾功能，直至移植肾活检显示急性排斥反应或无排斥反应。与使用硫唑嘌呤和泼尼松作为免疫抑制剂相比，使用环孢素A时，根据肾图判断的移植肾功能明显较差。在硫唑嘌呤和泼尼松组中，活检显示急性排斥反应之前肾图总是先出现恶化。在接受环孢素A治疗的患者中，肾图早期恶化后进行的移植肾活检仅56%显示急性排斥反应。无法确定肾图的时间进程或功能水平来预测这些患者的排斥反应。结论是，如果排除了移植后的手术并发症，在环孢素A治疗期间应广泛进行移植肾活检以诊断排斥反应。放射性核素研究可能有助于确定该药物的无肾毒性初始剂量。
