Newer clinical protocols of immunosuppression

These encouraging clinical results utilizing combinations of immunosuppressive agents represent relatively early attempts to adjust our immunosuppressive protocols to exploit the favorable effects of available agents while minimizing toxic effects. The results of our randomized study clearly show the deleterious effects of CsA toxicity, particularly in recipients of cadaveric grafts that do not function immediately. We chose to combine lower dosages of CsA with modified dosages of AzA, ALG, and prednisone. The early results in this protocol are excellent in recipients of related grafts, with early hospital discharge, lower necessary dosages of prednisone, and minimal early CsA nephrotoxicity. In cadaveric grafts, nephrotoxicity has also been reduced; however, serious infection has been a problem in several patients, and further modifications in dosages will be necessary to address this occasional over-immunosuppression. Longer follow-up of these patients and more rigorous comparative studies will be necessary before definitive proof of the effectiveness of these protocols is available.