Safety of Low-Dose Cyclosporine Therapy Before Transplantation in Kidney Allograft Recipients

IntroductionGraft dysfunction immediately posttransplantation can vary from subtle slowing of the expected decrease in creatinine concentration to frank oliguria requiring dialysis therapy for days to weeks. Risk factors for slow and delayed graft function include prolonged preservation, older donor age, and high plasma renin activity in the recipient. Cyclosporine (CsA) nephrotoxicity is another cause of early kidney allograft dysfunction.ObjectiveTo evaluate early kidney allograft function in patients who received low-dose CsA therapy for 48 hours before transplant surgery for comparison with that in recipients who received CsA therapy after improvement in allograft function.Patients and MethodsIn a case-control comparative study, 66 kidney recipients were divided into 2 groups on the basis of time of initiation of CsA therapy. In group 1, patients received CsA, 100 mg twice a day, for 48 hours before surgery, and in group 2, patients received CsA therapy after surgery when allograft function had improved (serum creatinine concentration ≤3 mg/dL). Other immunosuppression medications were the same in both groups. Statistical analysis was performed to compare kidney allograft function in the first month posttransplantation.ResultsIn group 1 vs group 2, at day 1 posttransplantation, mean (SD) blood urea concentration was 73.72 (31.00) mg/dL vs 87.52 (29.82) mg/dL, serum creatinine concentration was 5.11 (1.83) mg/dL vs 6.42 (3.64) mg/dL, and urine volume in 24 hours was 11,052 (4290) mL vs 9629 (45.30) mL. At the end of the study, blood urea concentration was 49.61 (12.18) mg/dL vs 69.11 (33.76) mg/dL, serum creatinine concentration was 1.22 (0.28) mg/dL vs 1.47 (0.79) mg/dL, and urine volume in 24 hours was 3202 (986) mL vs 3095 (726) mL. No significant difference was noted between the 2 groups for age, sex, and immunosuppression medications.ConclusionLow-dose CsA therapy before transplant surgery preserves early allograft function without deleterious effects.