NEW PATTERNS OF TRANSPLANT NEPHRECTOMY IN THE CYCLOSPORINE ERA

Several significant advances in transplantation during the last decade , among them the introduction of cyclosporine, have greatly altered th e management of allograft recipients. To determine the frequency and p attern of transplant nephrectomy (TN) since cyclosporine was introduce d in 1984, we reviewed our results from 1968 through 1990. During the 23 year period, 766 renal transplants were performed; 280 before 1984, when cyclosporine was first introduced into routine care and 486 afte r that time. Of the 280 recipients undergoing transplantion before 198 4, 70 underwent TN, whereas only 61 of the 486 recipients in the cyclo sporine period have undergone TN (P<0.01). Comparing the demographics of those who had TN before 1984 with those who had TN in the cyclospor ine era shows similarities: the mean age at TN (32 versus 32 years), p ercent male (66 versus 61), percent black (51 versus 61), percent of T N operations within six months of graft insertion (80 versus 70) and p ercent perioperative complications (nine versus 11). During the precyc losporine era, TN was performed more frequently in patients who receiv ed allografts from cadavers versus living related donors (30 versus 8 percent, p<0.05), but this difference was eliminated after 1983 (11 ve rsus 13 percent, p=NS). TN was performed more frequently after seconda ry versus primary transplants in the early (36 versus 23 percent) and later (23 versus 11 percent) time periods (p<0.05 only for the later t ime period). It is also noteworthy that the rate of TN decreased signi ficantly for primary and secondary transplants in the later time perio d. For low risk white patients and higher risk black patients the rate of TN decreased in an identical manner. We conclude that since the in troduction of cyclosporine, TN is performed less frequently, the frequ ency of TN in lower risk (primary, white) and higher risk (secondary, black, cadaveric) groups has decreased and TN has been and remains a s afe procedure.