Factors predicting the long-term success of maintenance cyclosporine monotherapy after kidney transplantation

Background. The theoretical aim of maintenance cyclosporine monotherapy (mC sA) after kidney transplantation is to reduce the incidence of the metaboli c complications of corticosteroids and to minimize the adverse effects of e xcessive long-term immunosuppression. This study was performed in low-immun ological-risk cadaveric kidney transplant recipients to evaluate the risks and benefits of mCsA and the longterm graft survival, and to determine the factors predicting success of this policy. Methods. The multicenter retrospective study was conducted in 329 Caucasian patients receiving mCsA out of 728 first cadaveric kidney transplant recip ients. The inclusion criteria were: HLA antibodies less than or equal to 25 %, serum creatinine <200 mu mol/L, and no rejection or only one rejection e pisode. At the end of the study, we compared the group of patients successf ully treated with mCsA (successful group) with those requiring additional i mmunosuppressive agents (unsuccessful mCsA group). Results. Overall patient and graft survival rates for the 728 first cadaver ic graft were 92% and 64%, respectively, at 8 years. Out of 329 patients en rolled in mCsA, 240 were maintained on this treatment and 89 were withdrawn (3 deaths, 18 graft losses, 68 functional grafts). The 8-year graft surviv al in the 329 enrolled mCsA patients was 84%, 95% in the successful mCsA gr oup, and 70% in the unsuccessful mCsA group. Multivariate analysis showed t hat the factors predicting success of mCsA were: donor age <40 years (P=0.0 01), serum creatinine at mCsA initiation <125 mu mol/L (P=0.02), no rejecti on episode before mCsA initiation (P=0.005), and glomerulopathy as the prim ary renal disease (P=0.001). Conclusion. Numerous kidney transplant recipients with a low immunological risk and good and stable renal function may benefit from discontinuation of prednisone and azathioprine in order to reduce the complications related t o these drugs. This therapeutic approach had no adverse impact on the overa ll longterm graft survival for "low risk" and successful patients.