Aichberger C, Eberl T, Riedmann B, Pernthaler H, Ofner D, Königsrainer A, Margreiter R
Department of Transplan Surgery, University Hospital Innsbruck, Austria.
Clin Transplant. 1996 Apr;10(2):209-12.
Cyclosporin A (CyA) together with steroids and azathioprine (Aza) has been successfully used for prophylactic immunosuppression in numerous recipients of kidney allografts. The aim of this study was to evaluate the long-term effect of reducing this initial triple-drug therapy to double-drug therapy at 3 months. One hundred consecutive recipients of a cadaveric renal allograft with stable and good graft function were randomly allocated to continue with CyA and steroids (group 1) or CyA and Aza (group 2). Both groups were comparable with regard to all relevant patient characteristics. After a mean observation period of 55 (26-76) months no significant difference was observed in the incidence of acute rejection episodes after conversion (4 in group 1 and 5 in group 2), or in the incidence of graft loss (4 in group 1 and 5 in group 2); all graft rejection episodes were easily reversed with steroid pulses and patients switched back to triple-drug therapy. Patient survival was 94% in group 1 and 100% in group 2 at 55 months. In group 1, however, a higher number of viral infections and steroid-related side effects was noted. From these data it is concluded that initial triple-drug therapy can safety be reduced to a CyA-based double-drug combination after 3 months in renal allograft recipients with stable function. The combination with Aza is recommended because of its fewer side effects.
环孢素A（CyA）与类固醇和硫唑嘌呤（Aza）一起已成功用于众多肾移植受者的预防性免疫抑制。本研究的目的是评估在3个月时将这种初始三联药物治疗减少为二联药物治疗的长期效果。100例尸体肾移植受者，移植肾功能稳定且良好，被随机分配继续使用CyA和类固醇（第1组）或CyA和Aza（第2组）。两组在所有相关患者特征方面具有可比性。平均观察期为55（26 - 76）个月后，转换后急性排斥反应的发生率（第1组4例，第2组5例）或移植肾丢失的发生率（第1组4例，第2组5例）均无显著差异；所有移植排斥反应均通过类固醇冲击治疗轻易逆转，患者转回三联药物治疗。55个月时，第1组患者生存率为94%，第2组为100%。然而，在第1组中，注意到病毒感染和类固醇相关副作用的发生率较高。从这些数据得出结论，对于移植肾功能稳定的肾移植受者，3个月后初始三联药物治疗可安全地减少为基于CyA的二联药物组合。由于副作用较少，推荐与Aza联合使用。
