title: Cyclosporine challenge test revisited: does it predict outcome after solitary pancreas transplantation?
abstract: BACKGROUND
  The selection of patients for solitary pancreas transplantation (PTA) requires identification of individuals who will not develop acute renal dysfunction in response to immunosuppressants. A cyclosporine challenge test (CCT) was developed to predict post-PTA kidney dysfunction secondary to calcineurin inhibitor immunosuppressants. We now report on the long-term follow-up of patients who received a PTA after undergoing a CCT.
  
  
  METHODS
  Twelve potential PTA recipients were administered cyclosporine A (CsA) for 6 wk. Creatinine clearance (CrCl) was measured at 2, 4, and 6 wk. Those who did not fail the CCT received PTA. Baseline and post-transplant CrCl were retrospectively evaluated in the original cohort and in a group of matched patients who received PTA without a CCT.
  
  
  RESULTS
  Of the original 12 recipients evaluated with the CCT, 6 received PTA. CrCl was followed for a mean of 45.8 months. Of the 4 who remained alive, 2 went on to develop renal failure (CrCl < 30 mL/min) at 18 and 65 months post-transplant. The baseline CrCl was higher in PTA recipients who had not been selected to be studied with CCT than those that were (117 +/- 32 vs 78 +/- 13 mL/min). By 12 months post-PTA, the CrCl was no longer different between the groups selected to be screened with CCT and those that were not.
  
  
  CONCLUSIONS
  CCT may help predict risk for short-term changes in renal function (< 18 months) in response to CsA. CCT may be most helpful in candidates for PTA with borderline renal insufficiency (60-80 mL/min).
authors.affiliation: Department of Internal Medicine, University of Nebraska Medical Center and NHS Hospital, Omaha 68198-3020, USA. jtlane1@unmc.edu
authors.forename: J T
authors.initials: JT
authors.lastname: Lane
authors.forename: T
authors.initials: T
authors.lastname: Ratanasuwan
authors.forename: R
authors.initials: R
authors.lastname: Mack-Shipman
authors.forename: R J
authors.initials: RJ
authors.lastname: Taylor
authors.forename: J P
authors.initials: JP
authors.lastname: Leone
authors.forename: S A
authors.initials: SA
authors.lastname: Miller
authors.forename: E R
authors.initials: ER
authors.lastname: Lyden
authors.forename: J L
authors.initials: JL
authors.lastname: Larsen
mesh_terms: D000328:Adult; D003404:Creatinine / Q000378:metabolism; D016572:Cyclosporine / Q000009:adverse effects*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D016035:Pancreas Transplantation; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000139:chemically induced*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine