Effects of initial cyclosporine dose and timing on long-term creatinine levels in cadaver renal transplantation

We undertook this study to determine the current immunosuppressive drug dosing trends and the resulting creatinine levels in a group of successful cadaver renal allograft recipients. We evaluated 320 patients, 80 from each of four centers, who were transplanted from 1985 through 1988. We found that initial cyclosporine doses differed between the four centers (17.5, 14, 12, and 8 mg/kg/day), but after the 1st year posttransplant, average cyclosporine doses were almost identical (6.0, 5.5, 5.2, and 5.5 mg/kg/d). Initial prednisone doses varied between 2 and 0.5 mg/kg/d, but after the 1st yr posttransplant the average doses were essentially identical. Two centers used azathioprine and antilymphoblast globulin and delayed the administration of cyclosporine by approximately 5 d. The average creatinine levels at 1 yr were 2.1, 1.9, 1.8 and 1.6 mg/dl and were highest at the two centers that gave large initial cyclosporine doses and began cyclosporine on the day of transplantation. Unexpectedly, the creatinine levels remained higher at these centers even though the cyclosporine doses were reduced. In conclusion, it appears that either the initial high cyclosporine doses and cyclosporine administration in the 1st week posttransplant caused elevated creatinine levels, or the added immunosuppression with azathioprine and antilymphoblast globulin produced greater antirejection efficacy and thus lower creatinine levels.