Kidney function in cyclosporine-treated paediatric pulmonary transplant recipients.
BACKGROUND
Lung or heart-lung transplantation is a useful therapy in life-threatening pulmonary disorders during childhood. Cyclosporine A is a major immunosuppressive treatment but has a number of adverse effects including nephrotoxicity. There have been no reports on the long-term evolution of renal function in a large series of paediatric pulmonary transplantation recipients.


METHODS
We examined 19 patients followed up for at least 3 years after pulmonary transplantation. The mean time of follow-up was 5.36 years. Kidney function was evaluated by calculation of glomerular filtration rate (GFR) according the Schwartz formula.


RESULTS
The GFR was normal before transplantation in all patients. The short-term evolution of GFR was marked by a significant drop during the first and until the 6th month. Then, regardless of the level reached at the end of the 6th month, the GFR remained stable in all patients except one until the end of follow-up. At the end of follow-up, 31% had normal GFR, 57% had mild chronic renal failure, and 5% had advanced renal failure. Hypertension was frequent and associated with renal failure.


CONCLUSIONS
Paediatric pulmonary recipients showed evidence of long-term cyclosporine A-associated nephrotoxicity. Most of this toxicity occurred during the first 6 months.
Tsimaratos
M
M
Department of Multidisciplinary Paediatrics, Paediatric Intensive Care, Hôpital d'Enfants, Groupe Hospitalier Timone, Marseille, France.
Viard
L
L
Kreitmann
B
B
Remediani
C
C
Picon
G
G
Camboulives
J
J
Sarles
J
J
Metras
D
D
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D007677:Kidney Function Tests; D016040:Lung Transplantation / Q000276:immunology / Q000502:physiology*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D017741:Survivors; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine