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Effect of cyclosporine A on long-term allograft function in pediatric renal transplant recipients
A W Williams1, B Z Morgenstern, M Murphy
1Department of Pediatrics, Mayo Clinic and Foundation, Rochester, Minnesota.
Insights
Cyclosporine A (CSA) did not significantly impair long-term renal allograft function in pediatric transplant recipients. Long-term follow-up showed no greater decline in kidney function for patients treated with CSA compared to those without.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation
Background:
- Cyclosporine A (CSA) is a key immunosuppressant in renal transplantation.
- Concerns exist regarding its long-term effects on renal allograft function.
Purpose of the Study:
- To evaluate the long-term impact of CSA on renal allograft function in pediatric recipients.
- To compare kidney function in patients treated with and without CSA up to 70 months post-transplant.
Main Methods:
- Retrospective study comparing two groups of pediatric renal transplant recipients.
- Assessed glomerular filtration rate (GFR) using iothalamate clearance.
- Analyzed GFR at 48 months and the rate of decline over 70 months.
Main Results:
- At 48 months, mean iothalamate clearance was similar between CSA and Pred/AZA groups (57.9 vs 68.5 ml/min per 1.73 m2, P > 0.05).
- The mean slopes of GFR decline over 70 months were not statistically different from zero in either group (-0.156 for CSA, 0.095 for Pred/AZA).
Conclusions:
- CSA does not appear to significantly depress renal allograft function at 48 months post-transplantation.
- No evidence suggests a greater rate of allograft function decline in CSA-treated patients up to 70 months compared to the AZA/Pred group.
Abstract:
There have been concerns regarding long-term adverse effects of cyclosporine A (CSA) on renal allograft function. In a retrospective study, we compared long-term allograft function up to 70 months after renal transplantation in pediatric recipients treated with and without CSA, using iothalamate clearance to assess glomerular filtration rate. Patients received CSA, prednisone, and azathioprine (CSA group, n = 16) or prednisone and azathioprine alone (Pred/AZA, n = 11). At 48 months post transplant, the iothalamate clearances (mean +/- SD) were 57.9 +/- 26.8 ml/min per 1.73 m2 in the CSA group and 68.5 +/- 20.2 in the Pred/AZA group (P > 0.05). The mean of the slopes of individual iothalamate clearances versus time during the first 70 months following transplantation were -0.156 in the CSA group and 0.095 in the Pred/AZA group. Neither slope was statistically different from zero. These data suggest that allograft function is not significantly depressed by CSA at 48 months post transplantation and that there is no greater rate of decline in allograft function up to 70 months post transplantation in patients receiving CSA when compared with the AZA/Pred group.