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

Abstract

In a selected group of patients, either Aza or low-dose CsA is safe and effective. Despite lower estimated glomerular filtration rate (eGFR) up to 10 years posttransplantation and increased use of anti-hypertensive agents, low-dose CsA was not associated with a worse patient or graft survival.

Influence of renal function on long-term graft survival and patient survival in renal transplant recipients

“…Findings from the PORT study concurred with those from the USRDS studies and also reported a significant increase in risk for graft loss with lower GFR at 12 months post-transplantation, using GFR 60-90 mL/ min/1.73 m 2 as the reference population 7 . Moreover, in studies performing multivariate analysis, reduced 12 month GFR remained a significant predictor for overall graft loss in all 7-10,13-16 but one study 17 . The association between reduced GFR and overall graft survival also remained consistent across different patient populations and recipients of both standard and extended criteria donor organs.…”

“…Nine of these studies were categorized as large scale (!500 patients) 7,8,10,12,15,18,20,23,25 , and the 13 studies that performed significance testing on the link between GFR and death-censored graft loss reported a significant association between reduced GFR and an elevated risk for death-censored graft loss 7,8,10,12,15,[17][18][19][20]22,23,25,26 . As expected, the magnitude of the relationship between declining GFR and graft survival was increased when censored for death.…”

“…Additionally, a total of 5 out of the 11 studies that assessed overall graft survival were conducted exclusively in European populations 9,12,[15][16][17] . Included studies investigated GFR (and change in GFR) at various time points posttransplantation, ranging from 1-3 months to 12 months post-transplantation.…”

“…The literature review identified a total of 11 studies that examined the relationship between GFR and overall graft survival [7][8][9][10][11][12][13][14][15][16][17] , and 17 studies examined death-censored graft survival 7,8,[10][11][12][15][16][17][18][19][20][21][22][23][24][25][26] . Four studies did not state whether graft survival was censored for death or not (Table 1) [27][28][29][30] .…”

Cyclosporine Withdrawal Improves Long-Term Graft Survival in Renal Transplantation

“…The findings of the 15-year follow-up of this study showed the beginnings of this divergence in survival curves (17), and this analysis confirms that the effects of alterations to immune suppression early in the transplant course have significant long-term implications. The comparable studies from the Netherlands (16) and Scotland (22) had less power and saw no differences in graft survival at 15 years. However, these studies showed inferior graft function and more chronic allograft nephropathy, both strong predictors of poorer graft outcome, in the long-term cyclosporine groups.…”