Ann Thorac Surg 1988;46:495-501
© 1988 The Society of Thoracic Surgeons
Articles
Cyclosporin A in Cardiac Transplantation: Medium-term Results in 62 Patients
Mohsin Hakim, F.R.C.S., M.R.C.P.*,
John Wallwork, B.Sc, F.R.C.S.,
Terence English, B.Sc, F.R.C.S.
Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, England
Accepted for publication June 8, 1988.
* Address reprint requests to Dr. Hakim, Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55901
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Abstract
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Between March, 1982, and October, 1984, 62 patients underwent orthotopic cardiac transplantation in our institution. Immunosuppression was based on cyclosporin A (Cy A) and low-dose steroids with an initial 10-day course of antithymocyte globulin. Follow-up ranged between 39 and 71 months (mean, 51.7 months). Actuarial survival at 1 year through 5 years was 80.6%, 77.4%, 74.2%, 71.4%, and 63.5%, respectively. Graft atheroma led to graft failure in 6 patients, 4 of whom died between 23 and 55 months after transplantation and 2 of whom had a repeat transplantation at 32 and 53 months. Diastolic hypertension (90 mm Hg or higher) developed in 88% of patients at 1 year. Chronic renal impairment was evident in all patients who survived for 2 years. Mean serum creatinine preoperatively and at 1 year through 4 years was 1.49 ± 0.08 mg/100 ml (± the standard error), 2.01 ± 0.09 mg/100 ml, 2.07 ± 0.09 mg/100 ml, 2.26 ± 0.19 mg/100 ml, and 2.32 ± 0.33 mg/100 ml, respectively. End-stage renal failure requiring regular hemodialysis developed in 3 patients, 2 of whom died. We conclude that in addition to graft atheroma, Cy A-related nephrotoxicity is emerging as a major cause of medium-term and long-term morbidity and mortality. The use of lower doses of Cy A in a triple-therapy protocol, that is, Cy A, azathioprine, and low-dose steroids, could help reduce the extent of renal impairment.
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Footnotes
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We are greatly indebted to Noreen Caine and David Spiegelhalter for their contribution to this work and statistical analysis of the data. We are also very grateful to Jane Irvine for her excellent secretarial assistance.
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References
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