Long-term graft outcome in patients with chronic allograft dysfunction after immunosuppression modiﬁcations
Amgad E. El-Agroudy, Khaled El-Dahshan, Khaled Mahmoud, Mahmoud El-Baz, Ahmed A. Shokeir, Mohamed A. Ghoneim
Ann Transplant 2008; 13(4): 46-54
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 â‰¤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, co-morbidities 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 function. Further prospective studies with larger cohorts are needed for validation.
Keywords: Chronic Allograft Dysfunction, immunosuppresion, long-term outcome