Valutazione a lungo termine della conversione da monoterapia con ciclosporina a duplice o triplice terapia nel trapianto renale

We retrospectively evaluated 143 first renal transplant recipients (120 from cadavers and 23 from living donors) receiving CsA monotherapy. The effects of both basal and time-dependent variables on 11-year graft survival were evaluated by Cox's analysis. Shifted patients were compared to the whole transplant population by means of 'landmark method' and Simon and Makuch's graphical representation. Graft half-life was calculated according to Cho and Terasaki. The mean follow-up was 85.8 months. Thirty-four percent of the patients remained on the original CsA monotherapy, while in the remaining 64% steroids had to be added. Cumulative patient and graft survival at 11 years were 0.89 and 0.62. Cumulative graft half-life was 19.98 years. By multivariate analysis, basal variables which correlated with a worse 11-year graft survival were: >45 months spent on dialysis (RR 3.17; p=0.001), no blood transfusion prior to transplantation (RR 2.58; p=0.008), CsA administration in a double daily dose (RR 2.13; p=0.018) and a transplant from a cadaver donor (RR 4. 72; p=0.032). In addition, Cox's analysis of time-dependent variables showed that delayed graft function recovery, (RR 2.43; p=0.007) and the need of adding steroids and/or azathioprine (RR 3.68; p