Cyclosporin A (CsA) is a unique immunosuppressive cyclic polypeptide that is currently being used, either alone or in combination with low-dose prednisone, to treat recipients of renal or pancreas allografts in clinical trials. CsA is very effective in preventing rejection of heart and renal allografts in rodents, but in nontoxic doses does not consistently prevent rejection of pancreas and islet allografts. Therefore, we tested low-dose CsA in various combinations with low-dose prednisone, azathioprine, or total lymphoid irradiation in rat heart, pancreas, and islet allograft models. Several combinations are synergistic and when administered continuously can indefinitely prevent rejection of heart allografts, but only delay rejection of pancreatic allografts, transplanted across a major histocompatibility barrier. CsA by itself prolonged the survival of islet allografts transplanted across a minor, but not a major, histocompatibility barrier. CsA and azathioprine had a synergistic effect in the minor histocompatibility barrler islet transplant model, but, in the nontoxic combinations tested, could not prevent rejection indefinitely. A randomized prospective trial comparing standard immunosuppressive therapy (ALG, prednisone, and azathioprine), with CsA and low-dose prednisone for clinical renal allotransplantation is ongoing at the University of Minnesota. Current actuarial 1-yr graft survival is 93% for CsA-treated patients (N = 48) and 81% for conventionally treated patients (N = 52). Patient survival is 98% for CsA and 100% for conventionally treated patients. A pilot trial of CsA in the clinical pancreas transplant program at the University of Minnesota is also underway. Since 1978, 46 pancreas transplants have been performed in 43 patients. Of 30 technically successful pancreatic allografts, 5 of 12 recipients treated with conventional immunosuppression and 6 of 18 recipients treated with CsA currently have functioning grafts and are insulin independent between 1 and 44 months after transplantation. The results of metabolic studies are similar in conventional and CsA-treated patients with functioning pancreas grafts. Since pancreas grafts may fail for reasons other than rejection, further observations are needed to ascertain the role of CsA in clinical pancreas transplantation.
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August 01 1982
Cyclosporin A for Immunosuppression: Observations in Rat Heart, Pancreas, and Islet Allograft Models and in Human Renal and Pancreas Transplantation
John J Rynasiewicz;
John J Rynasiewicz
Departments of Surgery and Medicine, University of Minnesota Health Sciences Center
Minneapolis, Minnesota
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David E R Sutherland;
David E R Sutherland
Departments of Surgery and Medicine, University of Minnesota Health Sciences Center
Minneapolis, Minnesota
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Ronald M Ferguson;
Ronald M Ferguson
Departments of Surgery and Medicine, University of Minnesota Health Sciences Center
Minneapolis, Minnesota
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Jean-Paul Squifflet;
Jean-Paul Squifflet
Departments of Surgery and Medicine, University of Minnesota Health Sciences Center
Minneapolis, Minnesota
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Charles E Morrow;
Charles E Morrow
Departments of Surgery and Medicine, University of Minnesota Health Sciences Center
Minneapolis, Minnesota
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Frederick C Goetz;
Frederick C Goetz
Departments of Surgery and Medicine, University of Minnesota Health Sciences Center
Minneapolis, Minnesota
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John S Najarian
John S Najarian
Departments of Surgery and Medicine, University of Minnesota Health Sciences Center
Minneapolis, Minnesota
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Address reprint requests to Dr. David Sutherland, Box 280 University of Minnesota Hospitals, 420 Delaware Street S.E., Minneapolis, Minnesota 55455
Citation
John J Rynasiewicz, David E R Sutherland, Ronald M Ferguson, Jean-Paul Squifflet, Charles E Morrow, Frederick C Goetz, John S Najarian; Cyclosporin A for Immunosuppression: Observations in Rat Heart, Pancreas, and Islet Allograft Models and in Human Renal and Pancreas Transplantation. Diabetes 1 August 1982; 31 (Supplement_4): 92–107. https://doi.org/10.2337/diab.31.4.S92
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