Impact of chronic allograft nephropathy and subsequent modifications of immunosuppressive therapy on late graft outcomes in renal transplantation

Giuseppe Montagnino, Giovanni Banfi, Maria Rosaria Campise, Patrizia Passerini, Adriana Aroldi, Bruno Mario Cesana, Claudio Ponticelli

Research output: Contribution to journalArticle

Abstract

Background. Chronic allograft nephropathy (CAN) is the leading cause of organ failure in renal transplant recipients. We retrospectively evaluated the impact of varying immunosuppression in CAN patients on long-term graft survival. Methods. We retrospectively analysed 158 cyclosporin (CsA)-treated renal transplant recipients with biopsy-proven CAN with follow-up of > 1 year. Immunosuppression remained unchanged in 75 (NOVAR) and was modified in 83 patients (VAR). In 36.1% of VAR patients, it was increased; in 63.8%, the addition of other immunosuppressants was associated with a 20% reduction in or withdrawal of CsA. A regression model, for creatinine clearance (CrCl) slope analysis after therapy variation, and Cox's analysis were applied. Results. In VAR patients, two-phase regression did not show a correlation between the inflection point in the CrCl slope and treatment variation. Changing immunosuppression gave a borderline advantage in long-term graft survival compared with NOVAR (P=0.088). In univariate analysis, severe histological lesions, proteinuria >0.5 g/day and CrCl

Original languageEnglish
Pages (from-to)2622-2629
Number of pages8
JournalNephrology Dialysis Transplantation
Volume19
Issue number10
DOIs
Publication statusPublished - Oct 2004

Keywords

  • Anti-rejection therapy variation
  • Chronic allograft nephropathy
  • Histology of chronic allograft nephropathy
  • Outcome assessment

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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