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Cyclosporine withdrawal improves long-term graft survival in renal transplantation

Gallagher, Martin, Jardine, Meg, Perkovic, Vlado, Cass, Alan, McDonald, Stephen, Petrie, James and Eris, Josette (2009). Cyclosporine withdrawal improves long-term graft survival in renal transplantation. Transplantation,87(12):1877-1883.

Document type: Journal Article

IRMA ID 84473293xPUB38
Title Cyclosporine withdrawal improves long-term graft survival in renal transplantation
Author Gallagher, Martin
Jardine, Meg
Perkovic, Vlado
Cass, Alan
McDonald, Stephen
Petrie, James
Eris, Josette
Journal Name Transplantation
Publication Date 2009
Volume Number 87
Issue Number 12
ISSN 0041-1337   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-67649586577
Start Page 1877
End Page 1883
Total Pages 6
Place of Publication United States
Publisher Lippincott Williams & Wilkins
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
The reduction in renal transplant rejection rates achieved over the last 20 years have not translated into a commensurate improvement in long-term graft survival. Cyclosporine has been central to immunosuppressive regimens throughout this period but its effect on long-term transplant outcomes remains unclear.

Methods
This randomized controlled trial allocated first cadaveric renal transplant recipients in seven centers around Australia to three immunosuppressive regimens: azathioprine and prednisolone (AP), long-term cyclosporine alone (Cy), or cyclosporine initiation followed by withdrawal at 3 months and azathioprine and prednisolone replacement (WDL).

Results
Between 1983 and 1986, 489 patients were randomized with 98% follow-up to a median of 20.6 years. Mean graft survival (censoring deaths) was superior in the WDL group (14.8 years) when compared with both AP (12.4 years, P=0.01 log-rank test) and Cy (12.5 years, P=0.01 log-rank test) groups by intention-to-treat. Without death censoring, graft survival with WDL was superior to AP (9.5 years vs. 6.7 years, P=0.04) and of borderline superiority to Cy (9.5 years vs. 8.5 years, P=0.06). Patient survival was not different between the three groups. Renal function was superior in AP (at 1, 10, and 15 years posttransplant) and WDL (at 1, 5, 10, 15, and 20 years) groups when compared with Cy.

Conclusion
This study illustrates superior long-term renal transplant survival and preservation of renal function with a protocol using cyclosporine withdrawal. If long-term renal transplant outcomes are to improve, we should reconsider guidelines recommending universal maintenance use of cyclosporine.
DOI http://dx.doi.org/10.1097/TP.0b013e3181a76823   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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