Long-term graft outcome in patients with chronic allograft nephropathy after immunosuppression modifications.
OBJECTIVE
This retrospective study was conducted to assess the efficacy and safety of immunosuppression conversion on progression of chronic allograft nephropathy (CAN).


METHODS
One-hundred and seventy-four cyclosporin (CsA)-treated renal transplant recipients were studied. Patients were included if they had a biopsy-proven CAN (mild to moderate) with serum creatinine < or =3.5 mg/dL. Patient treatment was switched to either: (A) MMF/reduced dose CsA (MMF for azathioprine (Aza); n = 132); or (B) Aza/Tac for CsA (n = 42). Patient records were checked for graft function and survival, and for co-morbidities after conversion.


RESULTS
Mean follow-up before conversion was 52.2 +/- 31.1 and 47.9 +/- 27.4 months for groups A and B, respectively. There was significant deterioration of graft function in group B after five years (P < 0.5). Ten-year actuarial graft survival was 38% in group A and 19% in group B (P = 0.04). Nine patients (five patients and four patients in groups A and B, respectively) started dialysis within 12 months. Tacrolimus-treated patients had a lower insignificant incidence of hyperlipidemia (P = 0.05), but a significantly higher incidence of diabetes mellitus (P = 0.04).There was no significant change or difference in blood pressure between groups.


CONCLUSIONS
Our results suggest that in patients with CAN and deteriorating allograft function, CsA minimization and addition of MMF achieved favorable efficacies in retarding the decline of graft function. Further prospective studies with larger cohorts are needed for validation.
El-Agroudy
Amgad E
AE
Urology and Nephrology Center, University of Mansoura, Mansoura, Egypt. amgadelagroudy@hotmail.com
El-Dahshan
Khaled F
KF
Mahmoud
Khaled
K
Ismail
Amani M
AM
El-Baz
Mahmoud
M
Shokeir
Ahmed A
AA
Ghoneim
Mohamed A
MA
D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D002908:Chronic Disease; D016572:Cyclosporine / Q000008:administration & dosage; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine; D016559:Tacrolimus