LONG-TERM IMPROVEMENT IN RENAL-FUNCTION AFTER CYCLOSPORINE REDUCTION IN RENAL-TRANSPLANT RECIPIENTS WITH HISTOLOGICALLY PROVEN CHRONIC CYCLOSPORINE NEPHROPATHY

Background. Chronic cyclosporine (CsA) nephropathy, which has been une quivocally documented in recipients of heart, heart-lung, liver, or bo ne marrow transplants, as well as in nontransplant situations, usually results in a progressive deterioration of renal function, In this stu dy, we assessed the potential reversibility of chronic CsA nephropathy in renal transplant recipients, Patients and Methods, Twenty-three re nal transplant patients with biopsy-proven CsA nephropathy associated with long-term CsA administration (27+/-4 months) were followed up for more than 2 years after CsA reduction (18/23 patients) or withdrawal (5/23 patients) and addition of azathioprine, Changes in effective ren al plasma flow and glomerular filtration rate were assessed before and 2 years after CsA reduction, whereas serum creatinine, proteinuria, b lood pressure, and CsA concentrations were monitored up to 5 years, Re sults, At a-year follow-up, glomerular filtration rate increased from 40+/-3 to 47+/-4 (P<0.05) and effective renal plasma flow from 217+/-2 3 to 244+/-24 ml/min/1.73 m(2) (NS). Mean arterial pressure significan tly decreased from 98.7+/-2.9 to 93.1+/-2.7 mmHg (P<0.05). There was n o significant change in renal vascular resistance, filtration fraction , or albumin excretion, A significant decrease in serum creatinine was also observed during the whole follow-up (73+/-6.5 months), CsA reduc tion was followed by only one episode of acute reversible rejection; c hronic rejection developed in three patients 2 years or later after Cs A reduction, Conclusions, These data suggest that CsA nephropathy part icipates in graft dysfunction in a small group of renal transplant rec ipients, In addition, graft dysfunction may be reversible when CsA dos age is reduced early after diagnosis of chronic CsA nephropathy.