Kidney function in cyclosporine-treated paediatric pulmonary transplant recipients

Background Lung or heart-lung transplantation is a useful therapy in life-t hreatening pulmonary disorders during childhood. Cyclosporine A is a major immunosuppressive treatment but has a number of adverse effects including n ephrotoxicity. There have been no reports on the long-term evolution of ren al function in a large series of paediatric pulmonary transplantation recip ients, Methods. We examined 19 patients followed up for at least 3 years after pul monary transplantation. The mean time of follow-up was 5.36 years. Kidney f unction was evaluated by calculation of glomerular filtration rate (GFR) ac cording the Schwartz formula. Results. The GFR was normal before transplantation in all patients. The sho rt-term evolution of GFR was marked by a significant drop during the first and until the 6th month. Then, regardless of the level reached at the end o f the 6th month, the GFR remained stable in all patients except one until t he end of follow-up. At the end of follow-up, 31% had normal GFR, 57% had m ild chronic renal failure, and 5% had advanced renal failure. Hypertension was frequent and associated with renal failure. Conclusions. Paediatric pulmonary recipients showed evidence of long-term c yclosporine A-associated nephrotoxicity. Most of this toxicity occurred dur ing the first 6 months.