Cyclosporin A withdrawal in live related renal transplantation: long‐term results

Dubey, Deepak; Kumar, Anant; Srivastava, Aneesh; Mandhani, Anil; Sharma, Ajay; Gupta, Amit; Sharma, RK

doi:10.1034/j.1399-0012.2001.150210.x

Cited by 15 publications

(5 citation statements)

References 20 publications

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“…The modification of immunosuppression is of some concern since the study of Dubey et al [33]documented an increased rejection rate of 27% after withdrawal of CsA. These results are comparable to earlier studies [2, 7].…”

Section: Discussionsupporting

confidence: 82%

Cyclosporin A Toxicity of the Renal Allograft – a Late Complication and Potentially Reversible

Sommerer

Hergesell²,

Nahm³

et al. 2002

Nephron

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Cyclosporin A (CsA) has improved patient and organ graft survival, but the dichotomy of benefit and toxicity is still an issue. In a retrospective analysis of 392 renal transplant recipients we documented CsA nephrotoxicity (striped fibrosis, arteriolar wall hyalinosis) in 28 (7.1%) patients (23 male/5 female) in a follow-up of more than one year post transplantation. Median age at renal transplantation was 41 years (13–60) and the period between transplantation and graft biopsy was 42 months (12–122). Median CsA trough levels (ng/ml) at 12 months post transplantation, at time of graft biopsy and at last follow-up were: 114 (71–265), 130 (78–285), 66 (24–115). The following parameters were assessed at 12 months post transplantation, at time of biopsy and at last follow-up: s-creatinine (µmol/l), Doppler resistive index, systolic and diastolic blood pressure (mm Hg) and the number of antihypertensives. Median s-creatinine at 12 months post transplantation was 150.3 (94.6–247.5), at biopsy 225.4 (121.1–353.6) and at last follow-up 160.0 (106.1–247.5) (p < 0.001 for biopsy vs. last follow-up). Resistive index decreased from 0.70 (0.64–0.88) to 0.68 (0.51–0.84) (p < 0.005), systolic blood pressure from 137 (100–168) to 130 (105–144) (p < 0.05) and the number of patients with more than 4 antihypertensives from 10 to 6 between biopsy and last follow-up, with no acute rejection episodes after modification of immunosuppressive therapy (50% of previous CsA trough level and addition of azathioprine or mycophenolate mofetil). Conclusion: CsA nephrotoxicity occurs late after renal transplantation with increased systolic blood pressure and Doppler resistive index. Reduction of CsA improves renal function, reduces graft resistive index and systolic blood pressure.

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Section: Discussionsupporting

confidence: 82%

Cyclosporin A Toxicity of the Renal Allograft – a Late Complication and Potentially Reversible

Sommerer

Hergesell²,

Nahm³

et al. 2002

Nephron

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“…CsA withdrawal and conversion from a triple-drug to a dual-drug based protocol has been reported to be an acceptable alternative in adult renal allograft recipients. We have also previously observed comparable graft survival in adult patients who discontinued CsA as compared to those who continued CsA (82% vs 91%) [4]. However, in the current study, children on azathioprine and prednisolone had significantly greater graft loss in comparison to children on CsA, prednisolone and azathioprine (41% vs 9%).…”

Section: Discussionsupporting

confidence: 41%

“…However, studies in adult patients reveal that graft outcome is satisfactory even when patients are converted from CsA-based immunosuppression to dual drug immunosuppression [4]. With regards to children, there are preliminary reports to suggest that outcome may be inferior in recipients on dual drug immunosuppression (on azathioprine and prednisolone).…”

Section: Introductionmentioning

confidence: 91%

Outcome of pediatric renal transplants in a developing country

Gulati

Kumar

Sharma

et al. 2004

Pediatric Nephrology

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This study was conducted to evaluate the outcome of pediatric renal transplants at our center. A retrospective analysis was done on 39 pediatric transplants (age at transplant <18 years) done at our center over the last 10 years. The mean age at transplant was 15.6+/-1 years (10-17 years). They comprised 4.2% of all renal transplants done at our center (39/921) over the period. Girls comprised 17.5% of total recipients ( n=7). Two patients had a preemptive transplant. The underlying causes of end stage renal disease were chronic glomerulonephritis ( n=21), chronic interstitial nephritis ( n=17) and Alport syndrome [1]. All the 39 children were initiated on triple drug immunosuppression (cyclosporin A (CsA) azathioprine, prednisolone). All patients received grafts from living related donors. In the first month, three patients had graft loss (serum creatinine, SCr, >5 mg/dl). Of these, two patients died because of septicemia and one had acute cortical necrosis. There was evidence of infection in 16 patients (40%). Acute rejection was seen in 17 patients (45.8%). The 1-year patient and graft survival was 89% and at 3 years 70%. The actuarial graft survival at 5 years was 50%. Twelve children discontinued CsA after 1 year post-transplant and five of these had graft loss. Graft losses were significantly greater in patients who discontinued CsA as compared to those who continued CsA (5/12 vs 2/22). After a mean follow-up of 31.5+/-3.5 months, of the 37 patients, 10 had graft loss and chronic graft dysfunction was observed in another 9 patients. The rest of the 17 (48%) patients had a mean SCr of 1.2 mg/dl. The long-term outcome of pediatric renal transplants in our country remains suboptimal. CsA discontinuation due to financial constraints and/or non-compliance remain the most important reasons for this.

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“…Concerns about the long term safety of CsA prompted this, and many other studies limiting its use either by converting to Aza (3)(4)(5)(6)(7)(8)(9)16), withdrawing CsA from a triple based regime (17)(18)(19) or by reducing the dose of CsA (20,21) at varying time intervals. The majority of these studies showed an increased incidence of acute rejection after early conversion to Aza, but no difference in graft and patient survival.…”

Section: Discussionmentioning

confidence: 99%

Randomized Study Comparing Cyclosporine With Azathioprine One Year After Renal Transplantation–15-Year Outcome Data

Joss¹,

Rodger²,

McMillan³

et al. 2007

Transplantation

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Cyclosporin A withdrawal in live related renal transplantation: long‐term results

Cited by 15 publications

References 20 publications

Cyclosporin A Toxicity of the Renal Allograft – a Late Complication and Potentially Reversible

Cyclosporin A Toxicity of the Renal Allograft – a Late Complication and Potentially Reversible

Outcome of pediatric renal transplants in a developing country

Randomized Study Comparing Cyclosporine With Azathioprine One Year After Renal Transplantation–15-Year Outcome Data

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