Low-Dose Versus High-Dose Cyclosporine Induction Protocols in Renal Transplantation

Current immunosuppressive therapies are effective to prevent acute
rejection episodes (ARE) and graft loss following renal transplantation. Newer agents now
make it possible to develop equally efficacious but better tolerated, less toxic strategies. We
compared the efficacy of early low- versus high-dose cyclosporine (CsA) induction therapy
in living donor renal transplantation.
Methods. In this single-center study, 90 consecutive recipients of living donor kidney
transplants between November 2002 to October 2003 including 51 females and mean
average age of 48.23 years were treated with either CsA (5 mg/kg/d) plus mycophenolae
mofetil (MMF; 30 mg/kg/d) and prednisolone (1 mg/kg/d; group 1; n � 42); or CsA (8
mg/kg/d) plus MMF (30 mg/kg/d) and prednisolone (1 mg/kg/d; group 2; n � 48). The 2
groups were matched with respect to age, sex, underlying renal diseases, pretransplantation
dialysis period, number of transplantations, and panel-reactive antibody tests. CsA
dose tapering was initiated in the 2 group 3 months after transplantation. At the end of the
first year, the CsA dose was 3.5 � 0.65 mg/kg in group 1 and 3.4 � 0.34 mg/kg in group 2.
Prednisolone was tapered within the first 2 months, reaching 10 mg/d in all patients. The
MMF dose remained unchanged. The 2 groups were compared with respect to ARE,
patient and graft survivals, and clinical outcomes within 2 years after transplantation.
Results. There were no significant differences between the 2 groups with respect to
clinical outcomes, including 2-year patient survival (97.62% vs 97.92%; P � .76), 2-year
graft survival (80.32% vs 80.41%; P � .82), ARE (47.61% vs 52.08%; P � .09), or length
of immediate postsurgical hospital stay, number of readmissions, total hospitalization days,
posttransplantation diabetes mellitus, and infectious, cardiovascular, gastrointestinal, and
hematologic complications. There was more hypertension (67.5% vs 50.23%; P � .007),
hypertriglyceridemia (45.5% vs 32.64%; P � .005), and elevated liver enzymes in group 2
(12.5% vs 7.14%; P � .018).
Conclusions. Compared with 8 mg/kg CsA induction therapy, the lower doses of CsA
were effective, well tolerated, and safe with relatively fewer side effects