Impact of long-term cyclosporine immunosuppressive therapy on native kidneys versus renal allografts: serial renal function in heart and kidney transplant recipients.
Impact of long-term cyclosporine immunosuppressive therapy on native kidneys versus renal allografts: serial renal function in heart and kidney transplant recipients.
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长期环孢素免疫抑制治疗对自体肾与肾同种异体移植物的影响：心脏和肾移植受者的连续肾功能。
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发表时间：
1991
期刊：
影响因子：
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通讯作者：
R. Kerman
中科院分区：
文献类型：
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作者：
R. Lewis;C. V. van Buren;B. Radovančević;O. Frazier;R. Janney;P. Powers;D. Golden;J. Giannakis;M. Macris;R. Kerman
对肾移植受者长期给予环孢素影响的综合分析报告称，移植物功能普遍受损但稳定。相比之下，肾外移植的经验表明，环孢素治疗超过12个月会导致进行性原发性肾病，通常导致透析依赖。本研究的主题是自体肾和同种异体肾移植之间明显差异的程度，该研究检查了119名肾移植受者和100名心脏移植受者接受12个月或更长时间的环孢素免疫抑制治疗后肾功能的变化。基于连续血清肌酐（Crs）测定，回顾性分析了两个研究队列中肾功能的演变。评估组平均Crs、Crs倒数（1/Crs）和通过绘制个体患者的1/Crs-时间曲线获得的曲线斜率，发现心脏同种异体移植组在移植后前6个月内自体肾功能显著下降。然而，此后，这些患者的天然肾功能稳定，总体趋势表明在3- 4年的随访期内功能没有进一步下降。肾移植受者有一个缓慢下降的整体趋势，与慢性免疫损伤的影响一致。数据与任一队列中进行性环孢素诱导的肾功能丧失的统一模式不一致。在心脏和肾移植队列中，发现长期使用环孢素与受损但总体稳定的总肾功能相关。（250字处删节）
Aggregate analyses of the impact of long-term cyclosporine administration in kidney transplant recipients have reported generally impaired but stable allograft function. In contrast, experience in extrarenal transplantation has suggested that treatment with cyclosporine for periods in excess of 12 months causes a progressive native nephropathy often leading to dialysis dependence. The extent of this apparent discrepancy between native kidneys and renal allografts is the subject of this study, which examines the evolution of renal function in 119 kidney and 100 heart transplant recipients receiving 12 or more months of cyclosporine immunosuppressive therapy administered in uniform protocols by affiliated clinical transplantation programs. The evolution of renal function in both study cohorts was analyzed retrospectively on the basis of serial serum creatinine (Crs) determinations. Assessment of group mean Crs, reciprocal Crs (1/Crs), and slopes of the curves obtained by plotting 1/Crs versus time in individual patients revealed a significant decline of native kidney function over the first 6 posttransplant months in the cardiac allograft group. Thereafter, however, native kidney function stabilized in these patients, and the aggregate trend was suggestive of no further decline in function over a 3- to 4-year follow-up period. Kidney transplant recipients had an aggregate trend of slowly declining allograft function consistent with the effects of chronic immunologic injury. The data were not consistent with a uniform pattern of a progressive, cyclosporine-induced loss of renal function in either cohort. Long-term use of cyclosporine was found to be associated with impaired but generally stable aggregate renal function in both the heart and the kidney transplant cohorts.(ABSTRACT TRUNCATED AT 250 WORDS)