Impact of cyclosporine withdrawal on living related renal transplants: A single-center experience

High treatment costs force the discontinuation of cyclosporine (CSA) in a v ast majority of renal transplant recipients in India. The impact of CSA wit hdrawal among 108 living related renal transplant recipients 12.54 +/- 4.2 months after transplantation was studied retrospectively. In 83 patients, C SA was withdrawn over a 12-week period (group I). Azathioprine dosage was i ncreased to 2 to 2.5 mg/kg/d, and prednisolone, to 30 mg/d 2 weeks and 1 we ek before starting CSA withdrawal, respectively. In the other 25 patients, CSA had to be withdrawn faster (mean, 28.52 +/- 14.18 days; group II). Twen ty-nine rejection episodes (26.9%) were noted in 22 patients (20.4%; 19% in group I and 52% in group II; P = 0.008). Fifteen group-I patients (18%) an d 11 group-II patients (44%) died or lost their grafts (P = 0.017). There w as no difference in age, donor source, HLA matches, pretransplantation cros s-match positivity, delayed graft function, immunosuppressive drug doses, r ejection episodes, or prewithdrawal serum creatinine levels between the pat ients who did or did not develop acute rejection after CSA withdrawal. On f ollow-up, 10 patients (50%) died or returned to dialysis among the rejectio n group compared with 16 patients (18%) in the nonrejection group (P = 0.00 7). The mean creatinine level at last follow-up was greater in the rejectio n group (3.97 +/- 2.54 versus 1.65 +/- 1.1 mg/dL; P < 0.001). CSA withdrawa l because of economic constraints carries a significant risk for acute reje ction and death and/or graft loss in Indian living donor renal transplant r ecipients, even after 12 months. (C) 2001 by the National Kidney Foundation , Inc.