Cyclosporine nephrotoxicity in cardiac allograft patients--a seven-year follow-up.
Renal function was observed retrospectively in a population of 228 adults who underwent a cardiac allograft at the University of Pittsburgh from June 1980 through June 1987, survived a minimum of one year, and received cyclosporine. Renal function was determined by serial measurement of serum creatinine concentration. Serum creatinine rose from 1.2 +/- 0.0 mg/dl at time of hospital discharge to 2.0 +/- 0.0 mg/dl at two and four years and 3.3 +/- 0.1 mg/dl at seven years. The fall in renal function was biphasic, with a rapid decline (reciprocal creatinine slope -0.018 dl/mg-mo) through 24 months and a slower decline thereafter -0.0036 dl/mg/month). This occurred despite a progressive decrease in cyclosporine levels from 668 +/- 23 ng/ml (whole blood RIA) to 380 +/- 12 ng/ml at seven years. Three of 222 patients (1.6%) developed end-stage renal disease within 18 months of initiation of cyclosporine therapy. Only one additional patient of 26 followed through 54 months (3.8%) developed end-stage disease thereafter. The decline in renal function seen with cyclosporine is rapid in the first 18 months, with a slower but continuing decline seen with later follow up. At least in heart transplantation, the risk of end-stage renal disease is significant, but not prohibitive.
Greenberg
A
A
Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania.
Thompson
M E
ME
Griffith
B J
BJ
Hardesty
R L
RL
Kormos
R L
RL
el-Shahawy
M A
MA
Janosky
J E
JE
Puschett
J B
JB
D000328:Adult; D003404:Creatinine / Q000097:blood; D003524:Cyclosporins / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D007676:Kidney Failure, Chronic / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D013997:Time Factors
D003524:Cyclosporins; D003404:Creatinine