FOLLOWING AN INITIAL DECLINE, GLOMERULAR-FILTRATION RATE STABILIZES IN HEART-TRANSPLANT PATIENTS ON CHRONIC CYCLOSPORINE

We previously reported that heart transplant patients given cyclospori ne for more than 2 years (short-term evaluation) had severe renal lesi ons and markedly reduced glomerular filtration rate and renal plasma f low (Kidney Int 40:243-250, 1991). We report the analysis of renal fun ction in the same patients after 3 additional years of followup (long- term evaluation) while they continued to take cyclosporine. Since the previous evaluation, the dose of cyclosporine was adjusted to maintain stable trough levels and antihypertensive therapy was unchanged. The mean time-averaged dose of cyclosporine during the follow-up was 4.5 /- 2.1 mg/kg/d. The systolic blood pressure at long-term evaluation (1 46 +/- 16 mm Hg) was increased (P < 0.05) compared with that at short- term evaluation (140 +/- 13 mm Hg), whereas diastolic blood pressure ( long-term 91 +/- 9 mm Hg v short-term 88 +/- 9 mm Hg) and mean blood p ressure (long-term 110 +/- 12 mm Hg v short-term 108 +/- 11 mm Hg) did not change significantly. Serum creatinine concentrations at long-ter m (1.7 +/- 0.3 mg/dl) and at short-term (1.7 +/- 0.4 mg/dL) evaluation s were similar. At long-term evaluation the renal plasma flow (300 +/- 64 mL/min/1.73 m(2)) was not decreased compared with that at short-te rm evaluation (325 +/- 94 mL/min/1.73 m(2)), while the glomerular filt ration rate increased significantly (43 +/- 15 mL/min/1.73 m(2) v 36 /- 8 mL/min/1.73 m(2), respectively; P < 0.05). None of the patients b ecame proteinuric after short-term evaluation; in those patients who w ere already proteinuric, urinary protein excretion did not increase ov er time. We conclude that after an initial remarkable decline in glome rular filtration rate, renal injury may stabilize in heart transplant patients on chronic cyclosporine. Whether this applies only to patient s who have a normal renal function to start with and maintain a substa ntial control of blood pressure during follow-up is worth investigatin g. (C) 1994 by the National Kidney Foundation, Inc.