The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 26-39, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Cyclosporine: an immunosuppressive panacea?
JG Copeland, RW Emery, MM Levinson, TB Icenogle, JE Riley, MJ McAleer, JA Copeland and R Dietz
Between March 29, 1979, and March 1, 1985, 62 heart transplants were done
in 61 patients at the University Medical Center, University of Arizona.
There were two treatment groups with nearly equal numbers in each;
conventional immunosuppression (1979 to 1982) and cyclosporine (1982 to the
present). Comparison of actuarial survival, number of rejection episodes,
number of fatal rejection episodes, number of infections, and number of
"other complications" failed to reveal any significant difference between
the two groups. The cyclosporine-treated patients had a documented increase
in blood urea nitrogen and serum creatinine accompanied by an increase in
diastolic blood pressure. The length of hospital stay of the cyclosporine
group was approximately one half of that of the conventionally treated
patients, and they required fewer rehospitalizations. The cost for initial
hospitalization was not significantly different between the two groups.
Therefore, in 1979 dollars, the cost for cyclosporine-treated patients has
decreased. This difference in cost was only minimally diminished by the
difference in expenditure for outpatient pharmaceuticals, which was four
times higher in the cyclosporine group. We believe that cyclosporine is a
potent immunosuppressive agent but that it has toxic, possibly irreversible
effects on the kidney. In view of the minimal differences that we were able
to demonstrate in survival rejection and infection, it seems prudent to
reduce or modify present doses of cyclosporine in an attempt to avoid
irreversible renal damage.
