Outcome of cadaveric renal transplant patients treated for 10 years with cyclosporine - Is chronic allograft nephropathy the major cause of late graft loss?

Background, The introduction of cyclosporine (CsA) has improved the short-t erm outcome of renal transplantation, but its effect on the long-term survi val is not well known. Methods. We analyzed 128 cadaveric first renal transplant recipients with C sA and prednisone as basal immunosuppression followed for at least 10 years , and we have compared them with a group of 185 historical patients treated with azathioprine (Aza) and prednisone. Results. The 1-year graft survival was 83% in the CsA-treated patients and 68% in the Aza-treated patients (P<0.025), and the differences were signifi cant for 3 years. Acute rejection accounted for the 10.9% of losses in CsA- treated patients and for 23.8% of losses in Aza-treated patients (P=0.046), Chronic allograft nephropathy was the cause of graft losses in 40.6% and 1 6.8% of cases (P=0.008), Patient survival at 5 years was 88% in CsA-treated patients and 79% in the Ate-treated patients (P<0.025), When analyzing the data of the 64 CsA-treated patients and the 84 Aza-treated patients with o ne functioning graft at 10 years, mean serum creatinine values were signifi cantly higher in the CsA-treated patients at all time points but the increa ses were not significantly different. At 10 years, mean blood pressure was higher (P=0.002), and hypercholesterolemia (P=0.011) rand hyperuricemia (P= 0.000) were more prevalent in the CsA-treated patients. Conclusions. CsA resulted in a better short-time patient and graft survival that was not maintained in the long-term outcome. Chronic allograft nephro pathy was the leading cause of graft loss in CsA-treated patients. Graft fu nction was poorer in the CsA-treated patients, but its decline was similar in the two groups.