Influence of treatment with cyclosporine, azathioprine and steroids on chronic allograft failure. The Collaborative Transplant Study.

The efficacy of different immunosuppressive regimens was analyzed in a multicenter series of cadaver kidney transplants reported to the Collaborative Transplant Study. Induction therapy with steroid-free cyclosporine regimens resulted in significantly better graft survival than induction including a combination of cyclosporine and steroids (P < 0.001) or azathioprine and steroids (P < 0.0001). Because immunosuppressive protocols frequently changed during the first post-transplant year, graft survival from the first to the fifth year was used to analyze the efficacy of long-term maintenance immunosuppressive regimens. Steroid-free maintenance with cyclosporine resulted in significantly better five-year graft survival (P < 0.0001) and patient survival (P < 0.01) than maintenance with steroid-containing cyclosporine regimens or maintenance on azathioprine and steroids without cyclosporine (P < 0.0001). Steroid-free patients received significantly higher doses of cyclosporine than patients on steroid-containing cyclosporine regimens. These results suggest that steroid-free maintenance immunosuppression with cyclosporine should be attempted in patients with an uncomplicated posttransplant course.