Detrimental effects of cyclosporin A on long-term graft survival in familial Mediterranean fever renal allograft recipients: experience of two transplantation centers.
BACKGROUND
Cyclosporin A has been associated with severe toxic side effects in patients with familial Mediterranean fever who underwent renal transplantation. Nevertheless, the impact on graft function and survival is not well documented.


OBJECTIVE
To compare long-term graft function and survival, between CsA-based vs. CsA free immunosuppressive protocols in FMF recipients of renal allograft.


METHODS
Data of FMF recipients were analyzed retrospectively. Graft survival and function and the incidence of acute rejection were correlated to graft source (living donor vs. cadaveric donor), colchicine dose, presence of proteinuria, and immunosuppression protocol (CsA-based triple drug therapy vs. azathioprine-prednisone alone).


RESULTS
There were 35 FMF patients with primary renal grafts (13 from living donors and 22 from cadaveric donors). Mean follow-up was 10.6 +/- 6.05 years. Sixteen patients were on CsA-based triple drug therapy and 19 patients on AZA-Pred alone. Mean overall graft survival was 11.2 +/- 0.6 years and 9.4 +/- 1.36 vs. 11.6 +/- 0.4 years for CsA-treated and AZA-Pred groups respectively (P = 0.05). One-year survival was 94% and 96.6% for CsA-treated vs. non-CsA patients (not significant), but 5 and 10 years survival were 76% and 46%, compared to 94.5% and 86% respectively (P = 0.05 at 5 years and 0.001 at 10 years). Mean serum creatinine at time of data collection was 2.3 +/- 1.5 mg/dl in the CsA group vs. 1.6 +/- 0.7 mg/dl in the AZA-Pred group (P = 0.02). There were 14 and 13 reversible rejection episodes in the AZA-Pred and CsA groups respectively (not significant).


CONCLUSIONS
It is suggested that CsA exerts detrimental effects on long-term renal graft function and survival in FMF patients.
Shabtai
Moshe
M
Departments of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel. mshabtai@post.tau.ac.il
Ben-Haim
Menahem
M
Zemer
Debora
D
Malinger-Saavedra
Patricia
P
Rosin
Dan
D
Kuriansky
Josef
J
Lustig
Shamir
S
Shabtai
Esther L
EL
Shapira
Zaki
Z
Ayalon
Amram
A
D000208:Acute Disease; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000494:pharmacology / Q000627:therapeutic use*; D010505:Familial Mediterranean Fever / Q000150:complications* / Q000235:genetics; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011507:Proteinuria / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine; D001379:Azathioprine; D003078:Colchicine; D008775:Methylprednisolone