PROGNOSTIC FACTORS OF LONG-TERM ALLOGRAFT SURVIVAL IN 632 CYA-TREATEDRECIPIENTS OF A PRIMARY RENAL-TRANSPLANT

A total of 632 cyclosporin (CyA)-treated primary renal allograft recip ients with a functioning graft at 6 months were retrospectively evalua ted for risk factors correlated with long-term allograft function. Mea n follow-up after the 6th month was 68.4 +/- 40.6 months. One hundred twenty-one of these patients (19 %) were lost: 29 died (23/29 with a f unctioning graft), 77 of the remaining 92 (83 %) lost their graft beca use of chronic allograft dysfunction, 9 due to recurrence of glomerulo nephritis, 5 due to renal artery thrombosis, and 1 due to chronic CyA toxicity. At univariate analysis, factors correlated with a better ren al (R) and pure renal (PR) allograft survival were: dialysis duration of less than 5 years, fewer than 2 rejections within the 6th post-Tx m onth, immediate graft function recovery, plasma creatinine below 1.5 m g/dl at the 6th month, age at Tx above 15 years, and receiving a livin g donor graft. Cox's regression analysis was also performed to obtain relative risks for the same parameters, Long-term dialysis patients ha d more frequent late recoveries (P = 0.002) and reductions in therapy (P = 0.01) in order to reduce the side effects of steroids. In young p atients receiving an initial oral CyA dose of 17 mg/kg per day, steroi ds were stopped at the 6th month in order to achieve catch-upgrowth: o nly one such patient lost his graft. In contrast, 72 % of the young pa tients who lost their grafts received an initial oral CyA dosage of 13 mg/kg per day. Thus, young patients did worse not because of steroid withdrawal, but because of inadequate initial CyA dosage. These result s suggest that although we cannot exclude alloantigen-independent mech anisms as factors that stimulate progression of chronic allograft dysf unction, it would appear that the initial lesions are induced by event s mostly mediated by immunological mechanisms.