Treatment of renal transplantation rejection. Cyclosporin A versus conventional treatment with azathioprine, prednisone and antithymocyte immunoglobulin in primary cadaveric renal transplantation.

In a prospective randomized clinical trial to compare treatment with cyclosporin A to conventional treatment with azathioprine, prednisone and antithymocyte immunoglobulin in cadaveric renal transplantation, 34 patients were entered into both treatment groups and were examined regularly for seven to 43 months. Renal graft survival at one year was 72% among patients receiving cyclosporin A therapy and 75% among those receiving conventional therapy. Rejection was a frequent complication of both treatments; irreversible rejection occurred in six patients receiving treatment with cyclosporin A and in 10 patients receiving conventional therapy. The nephrotoxicity of cyclosporin A was its main side-effect. A similar proportion of kidneys in both groups (65% and 69%) were initially affected with post-transplant oliguria, but recovery of function took significantly longer in the group receiving cyclosporin A therapy (median, 29 days versus 11 days, P less than 0.001). The results of this pilot study suggest that cyclosporin A can be used safely in patients with post-transplantation oliguria, and indicate that long-term graft survival with cyclosporin A is comparable to that achieved with azathioprine, prednisone and antithymocyte immunoglobulin.