Long-term renal function in cyclosporine-treated renal allograft recipients.
OBJECTIVE
The purpose of this study was to analyze the factors affecting long-term renal function in cyclosporine-treated kidney transplants.


METHODS
The study population comprised 167 patients with more than 5 years of graft function on cyclosporine therapy. Patients were subdivided into those with a serum creatinine level 2.0 mg/dL or less (group I, n = 123) versus those with a level more than 2.0 mg/dL (group II, n = 44) at 5 years post-transplant. Patient survival, graft survival, rejection episodes, renal function, cyclosporine dose and trough level, and proteinuria were compared in these two groups.


RESULTS
There was no significant difference between groups I and II in terms of race, sex, donor source, donor age, primary renal disease, retransplants, transfusions, presensitization, histocompatibility locus antigen match, or initial nonfunction. At 6 months post-transplantation, the mean serum creatinine level in group II was significantly higher than group I (P = 0.00001), and this difference increased at subsequent follow-up intervals. The incidence of proteinuria was significantly higher in group II compared with group I (P < 0.001). Renal allograft survival beyond 5 years post-transplant was significantly better in group I compared with group II (P = 0.005). There was no significant difference in the mean cyclosporine dose or the mean cyclosporine trough level between groups I and II at any time following transplantation. The most important difference between groups I and II was the finding of significantly more early (P < 0.001) and late (P < 0.001) rejection episodes in group II.


CONCLUSIONS
These data suggest that long-term renal function in cyclosporine-treated kidney transplant patients is primarily influenced by the occurrence of early and late rejection episodes rather than by the dosage or duration of cyclosporine therapy.
Tanabe
K
K
Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
Novick
A C
AC
Streem
S
S
Hodge
E
E
D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000097:blood / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D006937:Hypercholesterolemia / Q000209:etiology; D007239:Infections / Q000209:etiology; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011507:Proteinuria / Q000209:etiology; D016019:Survival Analysis
D016572:Cyclosporine; D003404:Creatinine; D001379:Azathioprine; D011241:Prednisone