Abstract
Calcineurin inhibitors (CNIs), such as cyclosporine A, have been known to negatively affect kidney function and the cardiovascular risk profile in kidney transplant recipients. Most recent trials on immunosuppressive therapy in this group of patients involve a calcineurin inhibitor in some form. While CNIs have markedly improved short term graft survival, the potential disadvantages of long term CNI use compared to CNI-free regimens have been less studied.
The object of this study was to present and compare data on long term kidney function, serum cholesterol, blood pressure and number of antihypertensive drugs used among kidney transplant recipients whose immunosuppressive regimen included cyclosporine A, azathioprine and prednisolone, compared to recipients who received azathioprine and prednisolone only.
214 cyclosporine A treated patients (Group A) were matched with a group of 117 historical controls (Group B) that had been treated conventionally without cyclosporine A. The groups were matched with respect to age at transplant, gender, source of graft and time from transplant to follow-up.
At an average of 6 years post-transplant, serum creatinine levels were significantly higher in Group A (153 vs 127 umol/l, p<0.005). The impact of cyclosporine A on blood pressure and cholesterol level could not be well elucidated, mainly due to study limitations associated with using historical controls. Two important factors for cardiovascular risk profile and graft outcome, nephrectomy of native kidneys and HLA-DR mismatch, were not available for analysis. In conclusion, the use of cyclosporine A was associated with a poorer kidney function compared to conventional immunosuppressive treatment of kidney transplant recipients.