CYCLOSPORIN A IN KIDNEY ALLOGRAFT WITH LONG-TERM PRESERVATION.

CYCLOSPORINE A (CsA) is a new immunosuppressive agent with unique properties; it suppresses humoral immunity to T cell-dependent antigens and also strongly suppresses cell-mediated immunity. Prolonged graft survival under CsA treatment has been achieved in a great variety of organs, several of which—nerve, muscle cells, small bowel, lung, and others—have been successfully grafted for the first time. Unfortunately, a substantial fraction of treated patients displayed toxic side effects, including hepatotoxicity, nephrotoxicity, fine tremor and hirsutism, which in most of the cases are dose related and reversible. Moreover, preliminary trials in man have provided that CsA should only be used in patients without primary anuria because of its nephrotoxixity. Nevertheless, recent pharmacokinetic studies showed that CsA is mainly metabolized in the liver, with less than the 10% excreted by the kidney. On this basis our group started to evaluate the effects of CsA in patients receiving long-term preserved cadaver kidney grafts and suffering from primary anuria.