Early and late forms of cyclosporine nephrotoxicity: studies in cardiac transplant recipients.

Published

Journal Article

To characterize the two forms of cyclosporine nephrotoxicity, we examined renal function in the immediate and late postoperative periods after cardiac transplantation. Moderate azotemia occurred during the first postoperative week in 58% of 43 cyclosporine-treated recipients, but in only 34% of 41 azathioprine-treated recipients, and 4% of 25 patients undergoing cardiopulmonary bypass for nontransplant surgery (both P less than .01 v cyclosporine). Acute renal failure developed in an additional 12% of the cyclosporine-treated group. Late postoperative renal dysfunction also occurred with a high prevalence. Life-table analysis indicated that at 6 months 55%, at 12 months 17%, at 24 months 4%, and at 36 months no cyclosporine-treated recipients retained normal renal function. Three renal biopsies performed in subjects with late nephrotoxicity demonstrated prominent interstitial fibrosis. Although one patient subsequently required chronic dialysis, reduction of cyclosporine dosage from a mean of 5.3 +/- 0.7 mg/kg/d to a mean of 2.3 +/- 0.3 mg/kg/d 9 to 21 months after transplantation with concurrent initiation of azathioprine therapy to prevent rejection led to an improvement of renal function in the five patients so treated. These data indicate that there are two distinct forms of cyclosporine nephrotoxicity. Although both occur with high prevalence, the early form does not appear to be a specific risk factor for the late form.

Full Text

Duke Authors

Cited Authors

  • Greenberg, A; Egel, JW; Thompson, ME; Hardesty, RL; Griffith, BP; Bahnson, HT; Bernstein, RL; Hastillo, A; Hess, ML; Puschett, JB

Published Date

  • January 1987

Published In

Volume / Issue

  • 9 / 1

Start / End Page

  • 12 - 22

PubMed ID

  • 3544821

Pubmed Central ID

  • 3544821

International Standard Serial Number (ISSN)

  • 0272-6386

Digital Object Identifier (DOI)

  • 10.1016/s0272-6386(87)80156-7

Language

  • eng

Conference Location

  • United States