Korean Journal of Nephrology 1985;4(2):276-282.

신이식후 Cyclosporine - A 치료경험

배종갑 , 이종원 , 박상훈 , 임천규 , 김명재

Abstract

Many workers have described the use of cyclo- sporine either alone or in combination with steroid in human renal allotransplantation. And encourag- ing preliminary statistics on patients and graft survival have been reported. In many studies, the use of cyclosporine has resulted in better graft survival than that attainable with conventional form of immunosuppression. However, its nephro- toxicity has made the management of renal trans- planted patients more complicated because of the difficulty of distinguishing CyA toxicity from other causes of depressed renal functions such as rejection and acute tubular necrosis. Monitoring of trough serum level of CyA facillitated its admission. Nephrotoxicity was managed either by reduction of the dose of CyA or by conversion to conventional immunosuppresants. The effect of CyA and steroid on renal allograft function and eventual graft outcome was analysed in 8 recipients. 7 recipients of living related donor(LRD) and 1 recipient of cadaveric donor (CAD) to whom the conventional drugs were given initially, then converted to CyA because of rejection unresponsive to steroid pulse therapy and leukopenia, hepatotoxicity. or vice versa due to nephrotoxicity. The result were as below; 1) CyA provided adequate selective immuno- suppression withont bone marrow suppression. 2) 6 of 8 patients experienced a rise in serum creatinine and that nephrotoxic epis cdes were treated by decreasing the daily dose of CyA. In patients whose serum creatinine subsequently rose over days following a dose decrease and they were treated for rejection episodes. 3) In all patients receiving CyA, only small do se of steroid was required or completely avoided. 4) In patients who were switched to CyA be- cause of uncontrollable side effects of conventional therapy and renal function were stable, the initial do se of about 7-8 mg/kg/day was required to maintain the trough serum level between 200 and 400 ng/ml with maintainance dose of 5mg/kg/day. 5) In patients who were switched to CyA be- cause of uncor itrollable rejection, much more dose of initial and maintainance as much as 10 mg/kg/ day. As a result, cyclosporine is a powerful immun- osuppressant that provides a vaIuable alternative to conventional methcds of immunosuppression. Although associated nephrctoxicity has not been satisfactorily explained or clinically resolved, we recommened the judicious use of cyclosporine in the majority of renal transplant recipients.