The use of MMF provides the opportunity to compare CNI withdrawal and cessation of steroids in the same trial. This innovative approach has been explored in a Dutch study [ 20 ]. At 6 months after transplantation, 212 patients were randomized to discontinuation of CsA, discontinuation of prednisone, or continued triple drug therapy comprising these two agents plus MMF. Interestingly, patients off steroids experienced a similar incidence of acute and chronic rejection than the triple therapy group and less than those without CsA 2 years after transplant surgery.
The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.
Cyclosporine can cause some side effects. About 25% of people taking cyclosporine develop high blood pressure (hypertension). In addition, because cyclosporine can be tough on the kidneys, it can cause a substance called uric acid to build up in the blood (a state known as hyperuricemia). Sometimes this buildup of uric acid can cause gout, a condition that causes intense swelling in one of the joints, often the the big toe. If you already have gout, your condition may worsen while taking cyclosporine. Fortunately, many of these side effects go away as treatment with cyclosporine is reduced or stopped, so your doctor can work with you to adjust your dosage if you begin to experience these problems.