Stability of renal allograft function associated with long-term cyclosporine immunosuppressive therapy--five year follow-up.
To examine the evolution of renal allograft function in kidney transplant recipients receiving long-term cyclosporine therapy, we evaluated 50 cadaveric and 30 living-related renal transplant recipients having graft survival greater than or equal to 12 months and an opportunity for 5 years of follow-up. Linear analysis of long-term allograft function in each patient was undertaken by plotting reciprocal serum creatinine (1/Crs) values vs. time. Mean follow-up was 49 +/- 18 months. Actual 3-year and 5-year allograft survivals were 83.8% (n = 80) [corrected] and 73.3% (n = 75) [corrected], respectively. Collective analyses of values of 1/Crs measured at yearly intervals and of the slopes of the curves obtained by plotting 1/Crs vs. time for each patient suggested that long-term use of CsA is associated with impaired but generally stable allograft function 1-5 years posttransplant. The aggregate rate of decline of renal allograft function in the study population did not differ from that of a historical control group consisting of 59 renal transplant recipients treated with a conventional prednisone-azathioprine immunosuppressive regimen. Donor source, diabetes, and diastolic hypertension (diastolic BP greater than 95 mmHg in more than half the follow-up readings) were not correlated with a more rapid rate of decline of allograft function as reflected in the slopes of the 1/Crs vs. time curves between 12 months posttransplant and the end of follow-up. In contrast, a significantly greater rate of decline of cadaveric allograft function was observed in patients with 12-month Crs values greater than 2.5 mg% and recipients of greater than 2 HLA-A,B-mismatched cadaveric kidneys. The data do not support an indication for routine conversion from CsA to azathioprine following successful renal transplantation.
Lewis
R M
RM
Division of Urology, University of Texas Health Science Center, Houston 77030.
Janney
R P
RP
Golden
D L
DL
Kerr
N B
NB
Van Buren
C T
CT
Kerman
R H
RH
Kahan
B D
BD
D000293:Adolescent; D000328:Adult; D003404:Creatinine / Q000097:blood; D003524:Cyclosporins / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000401:mortality
D003524:Cyclosporins; D003404:Creatinine; D011241:Prednisone