Impact of early or delayed cyclosporine on delayed graft function in renal transplant recipients:: A randomized, multicenter study

The benefit of delayed cyclosporine in reducing risk of delayed graft function (DGF) is not clearly established. This study compared early vs. delayed cyclosporine microemulsion (CsA-ME) in de novo renal transplant patients. Patients were randomized to early (day 0, n = 97) or delayed (day 6, n = 100) CsA-ME at an initial dose of 8 mg/kg/day with dose adjusted according to C-2 level. All patients received enteric-coated mycophenolate sodium (EC-MPS), steroids and an antiinterleukin-2 receptor antibody. In both groups, 33% of patients were at high risk of DGF; 26 patients (26.8%) in the early CsA-ME group and 23 patients (23.0%) in the delayed CsA-ME group experienced DGF (n.s.). Renal function at 3 months was comparable (creatinine clearance 51.1mL/min with early CsA-ME and 53.8mL/min with delayed CsA-ME), and remained similar to 12 months. Treatment failure, defined as biopsyproven acute rejection, graft loss or death, did not differ significantly at 12 months (23.7% with early CsA-ME vs. 29.0% with delayed CsA-ME). Biopsy-proven acute rejection occurred in 15.5% of early CsA-ME and 26.5% of delayed CsA-ME patients (n.s.). Both regimens were well tolerated. These data suggest that early or delayed introduction of CsA-ME results in similar renal function in renal transplant patients regardless of DGF risk level.