Long-term graft outcome in patients with chronic allograft dysfunction after immunosuppression modifications

作者：EI Agroudy Amgad E^*; EI Dahshan Khalled; Mahmoud Khalled; El Baz Mahmoud; Shokeir Ahmed A; Ghoneim Mohamed A

来源：Annals of Transplantation, 2008, 13(4): 46-54.

• chronic allograft nephropathy
• immunosuppression
• outcome

Background: This retrospective study was conducted to assess the efficacy and safety of immunosuppression conversion on progression of chronic allograft nephropathy (CAN).
Material/Methods: One hundred-seventy four cyclosporin (CsA)-treated renal transplant recipients were studied. Patients were included if they had a biopsy-proven CAN mild to moderate) with serum creatinine <= 3.5 mg/dL. Patients were treated with either: (A) MMF/reduced dose CsA [MMF for azathioprine (Aza)] (n=132); (B) Aza/Tac for CsA (n=42). Patient records were checked for graft function and survival commorbidities after conversion.
Results: Mean follow-up before conversion was 52.2 +/- 31.1 and 47.9 +/- 27.4 month in-group A and B, respectively. There was a significant deterioration of graft function in group B after 5-years (P<0.5). Ten-year actuarial graft survival was 38% in-group A and 19% in-group B (P=0.04). Nine patients started dialysis within 12 months. Tacrolimus-treated patients had a lower insignificant incidence of hyperlipidemia (P=0.05), but a significantly higher incidence of diabetes mellitus (P=0.04). There was no significant change or difference in blood pressure between groups.
Conclusions: Our results suggest that in patients with CAN and deteriorating allograft function, CsA minimization and addition of MMF achieved favorable efficacies in retarding the decline of graft funciton. Further prospective studies with larger cohorts are needed for validation. /

• 出版日期2008-12