Clinical research on active withdrawal of cyclosporine A in kidney transplantation recipients with stable renal function

Abstract

Objective To investigate the effect of the active withdrawal of cyclosporine A (CsA) on the incidence of acute rejection and long-term graft function in stable renal transplant recipients. Methods CsA withdrawal was offered to 35 recipients with stable renal function 6 months to 6 years posttransplantation [average, (13.3±9.1) months], including 23 eadaveric and 12 living- related kidney transplantations (33 were recipients of a primary and 2 of a second renal transplant). The recipients had taken mycophenolate mofetil (MMF) + sirolimus (SRL) + prednisone (Pred) irnmunosuppressive regimen after CsA withdrawal. Nine patients received transplanted kidney needle biopsy, and 8 patients had been examined for the HLA antibody assay before CsA withdrawal. Results Thirty-five recipients had been followed up for 6 months to 4. 5 years, with a mean time of 14. 8 months. The serum creatinine level before CsA withdrawal (88.1±15.5) μmol/L was different from that after conversion (92.3±23.7) μmol/L, P>0.05. Two episodes of biopsy confirmed acute allograft rejections were reversed after treatments. Side effects of CsA had been relieved, such as gingival hyperplasia, carbohydrate tolerance abnormity, polytrichosis, and so on. Three recipients with normal renal function had the lower degree of chronic allograft nephropathy in the histologic lesions. Seven recipients with negative HLA antibody maintained stable graft function after CsA withdrawal. One recipient with positive HLA antibody had proceeded to chronic allograft nephropathy and returned to hemodialysis. Conclusion Withdrawal of CsA in stable renal transplant recipients 6 months posttransplantation and conversion to MMF + SRL + Pred immunosuppressive regimen didn't increase the risk of acute rejection and were beneficial for eliminating toxic and side effects of CsA, but it was difficult to reverse the progress of chronic allograft nephropathy for positive HLA antibody recipients. Key words: Kidney transplantation;  Cyclosporine A;  Graft rejection;  Kidney function tests