Surg Gynecol Obstet 1980 Jul;151(1):17-26

The use of cyclosporin A and prednisone in cadaver kidney transplantation.

Starzl TE, Weil R 3d, Iwatsuki S, Klintmalm G, Schroter GP, Koep LJ, Iwaki Y,
Terasaki PI, Porter KA

Abstract
Eighteen patients were treated with primary cadaveric renal transplantation
using cyclosporin A therapy, and four more patients undersent cadaveric
retransplantation. Eleven of the 22 recipients were conditioned with lymphoid
depletion before transplantation, using thoracic duct drainage or lymphapheresis
for two to eight and one-half weeks. Cyclosporin A was begun a few hours before
grafting. The other 11 patients were pretreated with cyclosporin A for from one
day to 18 days. After transplantation, the majority of patients in both
subgroups of 11 had rejection develop, but in most, the immunologic process was
readily controlled with relatively small dosages of prednisone. After follow-up
periods of two to four and one-half months, one patient has died of the
complications of a coronary artery reconstruction that was not related to the
transplantation. Another graft was lost from rejection, and a third organ was
removed because of ureteral necrosis. Nineteen of the original 22 cadaveric
kidneys are functioning, including 17 of the 18 kidneys given to patients who
were undergoing transplantation for the first time. The only loss in the latter
group of 18 patients was in the patient who died after an open heart operation.
Results of these studies have shown that cyclosporin A is a superior and safe
immunosuppressive drug but that, for optimal use in cadaveric transplantation,
it usually should not be given alone. Steroid therapy greatly amplified the
value of cyclosporin A. Unless major delayed morbidity develops which is not
obvious so far, this drug combination should permit revolutionary advances in
the transplantation of all organs. Other adjuncts to the cyclosporin A-steroid
combination, including lymphoid depletion techniques, will require further
investigation.