A prospective randomized trial of pretransfusion/azathioprine/prednisone versus cyclosporine/prednisone immunosuppression in cardiac transplant recipients

preliminary results.

G. R. Barnhart, A. Hastillo, Mitchell Goldman, S. Szentpetery, T. C. Wolfgang, T. Mohanakumar, M. R. Katz, S. Rider, J. Hanrahan, R. R. Lower

Research output: Contribution to journalArticle

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Abstract

Cyclosporine has gained acceptance as the immunosuppressive agent of choice in cardiac transplantation, but the validity of this assumption has yet to be established. Since January 1983, 25 patients have been randomly assigned to receive either conventional immunosuppression (azathioprine/antithymocyte globulin/prednisone) and pretransplant transfusion (PAAP, n = 11) or cyclosporine immunosuppression (cyclosporine and prednisone [CyA], n = 14). There was no difference in the age distribution (41 +/- 9 vs 38 +/- 11 years), indications for transplantation, preoperative serum creatinine level (1.2 +/- 0.2 vs 1.4 +/- 0.3 mg/dl), or postoperative follow-up time (13.5 +/- 5.4 vs 13.5 +/- 5.2 months). Mortality was not different (PAAP = 2, CyA = 3) and there was no difference in rejection episodes per patient (PAAP = 1.8, CyA = 1.9). Patients in the PAAP group had more serious infections (PAAP = 8, CyA = 3; P less than .02), but those in the CyA group developed a greater incidence of systemic hypertension (PAAP = 1, CyA = 10; p less than .02), pericardial effusion (PAAP = 0, CyA = 6; p = .05), and impaired renal function (creatinine 1.5 mg/dl, PAAP = 2, CyA = 11; p less than .02). Thus it appears that in this small series, cyclosporine is not associated with a significant increase in early survival. It does appear that patients on PAAP immunosuppression develop a greater number of serious infections, but the incidence of rejection episodes appears to be the same. Renal dysfunction and hypertension in patients receiving cyclosporine continue to be long-term concerns and may add to the morbidity and mortality of patients treated with this immunosuppressive regimen.

Original languageEnglish (US)
JournalCirculation
Volume72
Issue number3 Pt 2
StatePublished - Sep 1 1985

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Azathioprine
Prednisone
Immunosuppression
Cyclosporine
Immunosuppressive Agents
Creatinine
Renal Hypertension
Antilymphocyte Serum
Pericardial Effusion
Mortality
Incidence
Age Distribution
Heart Transplantation
Infection
Transplant Recipients
Transplantation
Hypertension
Morbidity
Kidney
Survival

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

A prospective randomized trial of pretransfusion/azathioprine/prednisone versus cyclosporine/prednisone immunosuppression in cardiac transplant recipients : preliminary results. / Barnhart, G. R.; Hastillo, A.; Goldman, Mitchell; Szentpetery, S.; Wolfgang, T. C.; Mohanakumar, T.; Katz, M. R.; Rider, S.; Hanrahan, J.; Lower, R. R.

In: Circulation, Vol. 72, No. 3 Pt 2, 01.09.1985.

Research output: Contribution to journalArticle

Barnhart, GR, Hastillo, A, Goldman, M, Szentpetery, S, Wolfgang, TC, Mohanakumar, T, Katz, MR, Rider, S, Hanrahan, J & Lower, RR 1985, 'A prospective randomized trial of pretransfusion/azathioprine/prednisone versus cyclosporine/prednisone immunosuppression in cardiac transplant recipients: preliminary results.', Circulation, vol. 72, no. 3 Pt 2.
Barnhart, G. R. ; Hastillo, A. ; Goldman, Mitchell ; Szentpetery, S. ; Wolfgang, T. C. ; Mohanakumar, T. ; Katz, M. R. ; Rider, S. ; Hanrahan, J. ; Lower, R. R. / A prospective randomized trial of pretransfusion/azathioprine/prednisone versus cyclosporine/prednisone immunosuppression in cardiac transplant recipients : preliminary results. In: Circulation. 1985 ; Vol. 72, No. 3 Pt 2.
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abstract = "Cyclosporine has gained acceptance as the immunosuppressive agent of choice in cardiac transplantation, but the validity of this assumption has yet to be established. Since January 1983, 25 patients have been randomly assigned to receive either conventional immunosuppression (azathioprine/antithymocyte globulin/prednisone) and pretransplant transfusion (PAAP, n = 11) or cyclosporine immunosuppression (cyclosporine and prednisone [CyA], n = 14). There was no difference in the age distribution (41 +/- 9 vs 38 +/- 11 years), indications for transplantation, preoperative serum creatinine level (1.2 +/- 0.2 vs 1.4 +/- 0.3 mg/dl), or postoperative follow-up time (13.5 +/- 5.4 vs 13.5 +/- 5.2 months). Mortality was not different (PAAP = 2, CyA = 3) and there was no difference in rejection episodes per patient (PAAP = 1.8, CyA = 1.9). Patients in the PAAP group had more serious infections (PAAP = 8, CyA = 3; P less than .02), but those in the CyA group developed a greater incidence of systemic hypertension (PAAP = 1, CyA = 10; p less than .02), pericardial effusion (PAAP = 0, CyA = 6; p = .05), and impaired renal function (creatinine 1.5 mg/dl, PAAP = 2, CyA = 11; p less than .02). Thus it appears that in this small series, cyclosporine is not associated with a significant increase in early survival. It does appear that patients on PAAP immunosuppression develop a greater number of serious infections, but the incidence of rejection episodes appears to be the same. Renal dysfunction and hypertension in patients receiving cyclosporine continue to be long-term concerns and may add to the morbidity and mortality of patients treated with this immunosuppressive regimen.",
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AU - Hastillo, A.

AU - Goldman, Mitchell

AU - Szentpetery, S.

AU - Wolfgang, T. C.

AU - Mohanakumar, T.

AU - Katz, M. R.

AU - Rider, S.

AU - Hanrahan, J.

AU - Lower, R. R.

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