Comparative study of graft nephrectomy in pre-cyclosporine and cyclosporine era

To assess the incidence and identify the indications for graft nephrectomy (GN) in the cyclosporine (CSA) era as compared to GN in the pre-CSA era.

This is a retrospective study of 1,866 renal transplants done from 1971 to 1999. 675 were transplanted in the pre-CSA era (group 1) and 1,191 in the CSA era (group 2). The published series on experience with GN in the pre-CSA era was compared with that in the CSA era. GN done within 6 months of transplant was defined as early GN and those done after 6 months were included under late GN. The incidence, indication and the implications of GN were studied and compared with our experience in the pre-CSA era. Results were analyzed using the chi(2) test.

Of the 675 transplants in group 1, thirty-one had GN compared to 15 of 1,191 in group 2. There was a significant decrease in GN in the CSA era. Of the 31 in group 1, thirty had early GN as compared to 6 of 15 in group 2 (p = 0.003). On the contrary, late GN was significantly higher in group 2 (9/15) as compared to group 1 (1/31). Acute rejections and graft infections were the predominant causes of graft loss in group 1, while late graft loss due to symptomatic chronic rejection was the commonest cause in group 2. Morbidity was equal in both groups while mortality was significantly higher in group 1.

CSA has significantly reduced the need for GN. By reducing hyper, acute, and irreversible acute rejection, the need for early GN has also been reduced significantly. Though there is an increased incidence of chronic allograft nephropathy, late GN is indicated only when there is refractory hematuria, intractable proteinuria and graft sepsis. With better immunosuppression, graft loss secondary to infection has decreased and mortality due to GN has been minimized.