Who should be converted from cyclosporine to conventional immunosuppression in kidney transplantation, and why.
Twenty-three cadaveric renal allograft recipients with stable but compromised kidney function were electively converted from cyclosporine to azathioprine one year after transplantation. Within a few weeks glomerular filtration rate (GFR) rose by 40% and serum creatinine fell from 171 +/- 12 (mean +/- SEM) to 129 +/- 7 mumol/L. The increase in GFR was due to an increase in effective renal plasma flow of 21%. This suggests that one year of continuous cyclosporine (CsA) therapy does not result in irreversible structural renal damage. Although antihypertensive treatment was not changed, blood pressure fell from 142 +/- 4/90 +/- 3 to 123 +/- 3/77 +/- 2 mmHg. In addition a significant drop in serum cholesterol and triglycerides and an improvement in glucose tolerance were found. The beneficial effects on renal function, blood pressure, and metabolic indices were, however, outweighed by a high incidence of postconversion rejection in recipients of a second allograft. For these patients conversion from CsA to azathioprine seems therefore contraindicated. Recipients of a first kidney allograft can be converted safely, as long-term CsA administration in these patients induced a solid engraftment. The sequelae of the mode of treatment--impaired renal function, hypertension, and metabolic disturbances--are reversible even after late conversion.
Versluis
D J
DJ
Wenting
G J
GJ
Derkx
F H
FH
Schalekamp
M A
MA
Jeekel
J
J
Weimar
W
W
D001379:Azathioprine / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D003524:Cyclosporins / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D006084:Graft Rejection; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D016030:Kidney Transplantation; D008055:Lipids / Q000097:blood; D011241:Prednisone / Q000627:therapeutic use
D001786:Blood Glucose; D003524:Cyclosporins; D006680:HLA Antigens; D008055:Lipids; D003404:Creatinine; D001379:Azathioprine; D011241:Prednisone