TIME-COURSE OF THE DECLINE IN RENAL-FUNCTION IN CYCLOSPORINE-TREATED HEART-TRANSPLANT RECIPIENTS

The renal side-effects are a major limitation of the use of cyclospori ne A (CsA) following heart transplantation. In an effort to define the time course of the decline in renal function and to identify a group of patients especially prone to the nephrotoxic effects of CsA, we stu died 187 orthotopic heart transplant recipients who had a follow-up of at least 1 month. Ah patients received oral CsA in a starting dose of 8 mg/kg and low-dose steroids. Renal function decreased steadily afte r transplantation. Serum creatinine was > 150 mu mol/1 in 52% of the p atients after 2 years. After 4 years serum creatinine was > 250 mu mol /1 in 13% of the patients. No relation could be found between the decl ine in renal function (as defined by the slope of serum creatinine(-1) versus time) and age, sex, creatinine levels before transplantation, blood pressure, CsA blood levels, the number of rejections or the use of calcium channel blocking drugs. We conclude that, despite reduction of CsA dosage, progressive renal insufficiency can be observed in an increasing percentage of heart tansplant recipients. We were not able to identify patients with a poor renal prognosis in an early phase aft er transplantation.