Long-term renal function in heart transplant recipients receiving cyclosporine therapy.
BACKGROUND
Immunosuppression with cyclosporine has improved allograft function and reduced both morbidity and mortality in organ transplantation. However, cyclosporine-induced nephrotoxicity still is a concern. The purpose of our study was to evaluate the effects of cyclosporine on renal function in orthotopic heart transplant recipients.


METHODS
Thirty-nine patients who received transplants from 1985 to 1991 and had at least three yearly glomerular filtration rate measurements posttransplantation by 125I-iothalamate clearance method were included in the study. In addition, serum creatinine (before and after transplantation) and cyclosporine doses were analyzed.


RESULTS
Maintenance immunosuppression at 1 year consisted of prednisone (0.1 mg/kg/day), azathioprine (2 mg/kg/day), and cyclosporine (12-hour trough level 100 to 150 ng/ml by fluorescence polarization immunoassay). The mean serum creatinine at 1 year was significantly higher than the mean pretransplantation serum creatinine (1.51 +/- 0.32 versus 1.28 +/- 0.38, p < 0.05) and stabilized after the first year. The mean glomerular filtration rate by 125I-iothalamate clearance method was 70.6 +/- 20.3 ml/min/1.73 m2 (range 32 to 105) at 1 year and remained relatively stable during the follow-up period of up to 7 years. Creatinine clearance calculated by the Cockcroft and Gault formula overestimated the true glomerular filtration rate after the third year. The mean cyclosporine dosage was significantly lower after the first-year dose of 3.9 +/- 1.8 mg/kg/day (p < 0.05). Three patients in 39 started hemodialysis at 5, 7, and 10 years after transplantation.


CONCLUSIONS
Our data indicate that the adequacy of renal function is preserved with long-term cyclosporine therapy in heart transplant recipients.
Goral
S
S
Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tenn. 37232-2372, USA.
Ynares
C
C
Shyr
Y
Y
Yeoh
T K
TK
Johnson
H K
HK
D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007457:Iodine Radioisotopes; D007483:Iothalamic Acid; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage
D007166:Immunosuppressive Agents; D007457:Iodine Radioisotopes; D007483:Iothalamic Acid; D016572:Cyclosporine; D003404:Creatinine; D001379:Azathioprine; D011241:Prednisone