The Annals of Thoracic Surgery, Vol 46, 382-388, Copyright © 1988 by The Society of Thoracic Surgeons
Incidence and severity of acute cardiac allograft rejection with two different low-dose cyclosporine maintenance protocols
G Laufer, A Laczkovics, G Wollenek, W Schreiner, I Kober and E Wolner
Department of Surgery II, University of Vienna, Austria.
Currently cyclosporine (CyA) represents the main immunosuppressive agent
used after cardiac transplantation and usually is administered in
combination with prednisone and/or azathioprine for prevention of graft
rejection. From March, 1984, to August, 1987, 53 patients underwent
orthotopic heart transplantation for terminal-stage heart disease at the
Second Department of Surgery, University of Vienna. All patients received
CyA in increasing dosage (3 mg/kg to 6-10 mg/kg) postoperatively according
to renal function, obtaining a trough high- pressure liquid chromatographic
whole-blood target level of 200 to 400 ng/ml at the end of the first week.
CyA was subsequently tapered to 100 to 150 ng/ml after 6 months. From
March, 1984, through April, 1986, maintenance immunosuppression was carried
out with a double-drug regimen of CyA and azathioprine. Since May, 1986, a
triple-drug schedule was applied with CyA, azathioprine, and prednisone.
Under triple-drug therapy, the incidence of mild, moderate (p less than
0.0001), and severe (p = 0.05) allograft rejection proven by endomyocardial
biopsy decreased significantly with a corresponding increase of absent (p
less than 0.0001) rejection. Freedom from moderate, severe, and lethal
graft rejection, number of rejection episodes per patient after 1 year
(double drug, 1.0, versus triple drug, 2.5), and patient survival disclosed
significant improvement for recipients of the triple-drug regimen. Both
groups had the same incidence of infectious complications; freedom from
death by infection after 1 year was 90% versus 91% (double versus triple
drug, p = 0.20).(ABSTRACT TRUNCATED AT 250 WORDS)
