Long-term renal function in heart transplant recipients receiving cyclosporine therapy

• Published in: The Journal of heart and lung transplantation Vol. 16; no. 11; p. 1106
• Main Authors: Goral, S, Ynares, C, Shyr, Y, Yeoh, T K, Johnson, H K
• Format: Journal Article
• Language: English
• Published: United States 01.11.1997
• Subjects: Adolescent; Adult; Azathioprine - administration & dosage; Creatinine - blood; Cyclosporine - administration & dosage; Cyclosporine - adverse effects; Cyclosporine - therapeutic use; Female; Glomerular Filtration Rate - drug effects; Heart Transplantation; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Iodine Radioisotopes; Iothalamic Acid; Kidney - drug effects; Kidney - physiology; Male; Middle Aged; Prednisone - administration & dosage
• ISSN: 1053-2498

Immunosuppression with cyclosporine has improved allograft function and reduced both morbidity and mortality in organ transplantation. However, cyclosporine-induced nephrotoxicity still is a concern. The purpose of our study was to evaluate the effects of cyclosporine on renal function in orthotopic heart transplant recipients. Thirty-nine patients who received transplants from 1985 to 1991 and had at least three yearly glomerular filtration rate measurements posttransplantation by 125I-iothalamate clearance method were included in the study. In addition, serum creatinine (before and after transplantation) and cyclosporine doses were analyzed. Maintenance immunosuppression at 1 year consisted of prednisone (0.1 mg/kg/day), azathioprine (2 mg/kg/day), and cyclosporine (12-hour trough level 100 to 150 ng/ml by fluorescence polarization immunoassay). The mean serum creatinine at 1 year was significantly higher than the mean pretransplantation serum creatinine (1.51 +/- 0.32 versus 1.28 +/- 0.38, p < 0.05) and stabilized after the first year. The mean glomerular filtration rate by 125I-iothalamate clearance method was 70.6 +/- 20.3 ml/min/1.73 m2 (range 32 to 105) at 1 year and remained relatively stable during the follow-up period of up to 7 years. Creatinine clearance calculated by the Cockcroft and Gault formula overestimated the true glomerular filtration rate after the third year. The mean cyclosporine dosage was significantly lower after the first-year dose of 3.9 +/- 1.8 mg/kg/day (p < 0.05). Three patients in 39 started hemodialysis at 5, 7, and 10 years after transplantation. Our data indicate that the adequacy of renal function is preserved with long-term cyclosporine therapy in heart transplant recipients.