Clinical Retrospective Study Of Cyclosporine A For Intravenous Drip On Treatment Of Steriod-resistant Acute Rejection(SRAR) Following Kidney Transplantation

Objective To evaluate the efficacy and safety of induction therapy with Cyclosporine A for intravenous drip on treatment of steriod-resistant acute rejection(SRAR).Methods The Clinical data of 50 patients with SRAR were analyzed retrospectively in148 patients with acute rejection after allograft kidney transplantation from2011.01-2014.12.Fifty recipients of first allogenic renal transplantation were randomized into 2 groups:(1)Experimental group(accepting Cyclosporine A for intravenous drip,n=28).(2)Control group(accepting ATG,n=22).HLA typing,ABO blood typing,cross-matching and panel reactive antibody(PRA)monitoring were performed preoperatively.Tacrolimus/cyclosporine,mycophenolate mofetil,and steroids were adopted as immunosuppressants after transplantation in renal allograft recipients.SRAR was diagnosed and classified by clinical manifestations,color Dopple ultrasonography and pathological biopsy of transplanted kidney.Above of immunosuppressive therapy regimen was used after the diagnosis.Reversal rate of SRAR,serum creatinine,infection after transplantation and incidence of adverse events were analyzed and compared,follow up for tow years.Results The reversal rate of SRAR was 75%(21/28)and 81.8%(18/21)in experimental and control group(P>0.05).The incidence of adverse events in the experimental group was 14.3%(4/28),significantly lower than 50%(11/22,P<0.05)in the control group。The rate of infection in the experimental group was 14.3%(4/28),significantly lower than 45.5%(10/22,P < 0.05)in the control group.Serum creatinine level of experimental group and control group at 0、 3、6、12、24 months after treatment was134.7±23.6(umol/L)、(132.6±24.1)ummol/L、(131.2±29.7)ummol/L、(128.5±28.2)ummol/L、(144.7±28.5)ummol/L and 130.8±24.2(ummol/L)、(128.6±28.1)ummol/L、(126.2±26.8)ummol/L、(135.6±27.2)ummol/L、(139.7±31.5)ummol/L(P>0.05)respectively after initial rejection.Conclusion Cyclosporine A for intravenous drip can be used effectively and safely in the treatment of steriod-resistant acute rejection after renal transplantation,and more affordable.