LATE WITHDRAWAL OF CYCLOSPORINE IN STABLE RENAL-TRANSPLANT RECIPIENTS

The use of cyclosporine (CsA) in renal transplantation has been associ ated with an improvement in 1-year graft survival, but has not changed the rate of late graft loss, We sought to determine whether the inten t to withdraw CsA late after renal transplantation affects renal trans plant survival and whether there is a racial difference in the effect of CsA withdrawal. This retrospective study included 384 consecutive p atients receiving a renal transplant during the 1984 to 1991 period wh o were treated with CsA/azathioprine/prednisone and who had a function ing allograft 6 months following transplantation. Of these, 97 were el ectively withdrawn from CsA at a median of 22 months following transpl antation. Factors significantly associated with the decision to withdr aw CsA included white race, older age, and lower serum creatinine. Acu te rejection within 6 months of stopping CsA occurred in 12 patients ( 12.4%), including nine of 78 (11.5%) white patients and three of 19 (1 5.8%) black patients. For the group of 287 patients who were not withd rawn from CsA, the 6-year graft survival rate was 59% (95% confidence interval, 52%, 66%). For the group of patients taken off of CsA, the 6 -year graft survival rate was 84% (95% confidence interval, 76%, 92%). Cox proportional hazard survival analysis indicated that the intent t o discontinue CsA was associated with better graft survival, with a ha zard ratio of 0.37 (95% confidence interval, 0.20, 0.70), independent of other variables that may affect graft survival. A separate analysis controlling for waiting time bias also favored the CsA withdrawal gro up, There was no detectable racial difference in the effect of CsA wit hdrawal on graft survival. Withdrawal of CsA in selected stable patien ts at a median of 22 months after transplantation is a reasonable opti on, but carries a significant risk of acute rejection. Older white pat ients with good renal function may be the best candidates for CsA with drawal. (C) 1995 by the National Kidney Foundation, Inc.