1992 Volume 83 Issue 4 Pages 528-535
We performed in total 528 kidney transplantations from Feb. 1983 to Dec. 1988 in Kidney Center of Tokyo Women's Medical College. Of the 528 kidney transplantations, 450 were living related kidney transplantations.
The living related renal transplant recipients treated with CYA were devided into 3 groups: high dose CYA double drug therapy group (group 1), high dose CYA triple drug therapy group (group 2) and low dose CYA triple drug therapy group (group 3).
Group 1 (n=263) was treated with CYA (initial dose 12mg/kg) and methylprednisolone (MP). Group 2 (n=106) was treated with CYA (initial dose 10mg/kg), MP and azathioprine (AZ) (1mg/kg). Immunosuppression of group 3 (n=81) consisted of CYA (initial dose 6mg/kg), MP and AZ (2mg/kg) (or mizoribine (MZ) (3-5mg/kg).
CYA serum trough level (polyclonal) was lowered according to the initial dose of CYA, and in particular trough level in group 3 was controlled at a low level (50-150ng/ml in induction phase) to reduce CYA nephrotoxicity.
However, even if strict control of serum trough level was accomplished, we could not get improvement of renal function in Group 3.
Group 3 had more frequent and severe accelearted acute rejections (AAR) than the other groups. These data showed that inadequate immunosuppression in group 3 caused more frequent and severe rejection episodes.
Also, renal biopsy revealed CYA nephrotoxicity even in group 3 and this nephrotoxicity may have been caused by ischemic damage by severe rejections.
We think 6mg/kg/day of CYA is not adequate for immunosuppression and 8mg/kg/day of CYA may be the optimal initial dose for living related renal transplantation.
