THE IMPACT OF LONG-TERM CYCLOSPORINE-A THERAPY ON HEMATOLOGICAL AND BIOCHEMICAL PROFILE IN RENAL-TRANSPLANT PATIENTS

With over a decade of extensive clinical use of cyclosporin A (CsA), a ssessment of its long-term safety implications is due. In this study t he impact of long-term continuous use of CsA on a number of hematologi cal and biochemical parameters in renal transplant patients was evalua ted. Two groups of 13 patients each, one on conventional therapy (azat hioprine + prednisolone) and the other on triple therapy (azathioprine + prednisolone + CsA) for 4 to 15 years post-transplantion were compa red with respect to their current and overall laboratory values and cl inical outcome. Laboratory values were also compared with those of 23 matched healthy subjects. No significant difference in the clinical ou tcome was found between conventional and triple therapy groups, howeve r, the triple therapy group had significantly less favorable mean valu es compared to the conventional therapy group with respect to hemoglob in (12.1 +/- 2.2 vs 13.3 +/- 2.1 g/dl, p < 0.02), hematocrit (0.36 +/- 0.06 vs 0.42 +/- 0.03 l/l, p < 0.05), urea (13.0 +/- 3.7 vs 6.7 +/- 4 .3 mmol/l, p < 0.01) and uric acid (460.0 +/- 112 vs 330 +/- 88 mu mol /l, p < 0.05). The increase in serum uric acid levels in the triple th erapy group was progressive throughout the post-transplant period. For the 19 other parameters measured corresponding mean values in the 2 g roups were comparable. Mean laboratory values for many parameters in b oth groups, however, still differed from those in the control group. T hese results showed that kidney transplant patients on long-term tripl e therapy have more hematological and biochemical abnormalities and no better clinical outcome than those on conventional therapy. Inclusion of CsA in long-term maintenance therapy is, therefore, not recommende d as it predisposes to clinical complications such as gout, while prov iding no clinical advantage.