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Cyclosporine challenge test revisited: does it predict outcome after solitary pancreas transplantation?
Author(s) -
Lane James T,
Ratanasuwan Tanaporn,
MackShipman Lynn R,
Taylor Rodney J,
Leone John P,
Miller Suzanne A,
Lyden Elizabeth R,
Larsen Jennifer L
Publication year - 2001
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1034/j.1399-0012.2001.150105.x
Subject(s) - medicine , calcineurin , renal function , urology , transplantation , pancreas transplantation , creatinine , kidney , cohort , kidney transplantation , surgery , gastroenterology
Background: The selection of patients for solitary pancreas transplantation (PTA) requires identification of individuals who will not develop acute renal dysfunction in response to immunosuppressants. A cyclosporine challenge test (CCT) was developed to predict post‐PTA kidney dysfunction secondary to calcineurin inhibitor immunosuppressants. We now report on the long‐term follow‐up of patients who received a PTA after undergoing a CCT.
Methods: Twelve potential PTA recipients were administered cyclosporine A (CsA) for 6 wk. Creatinine clearance (CrCl) was measured at 2, 4, and 6 wk. Those who did not fail the CCT received PTA. Baseline and post‐transplant CrCl were retrospectively evaluated in the original cohort and in a group of matched patients who received PTA without a CCT.
Results: Of the original 12 recipients evaluated with the CCT, 6 received PTA. CrCl was followed for a mean of 45.8 months. Of the 4 who remained alive, 2 went on to develop renal failure (CrCl<30 mL/min) at 18 and 65 months post‐transplant. The baseline CrCl was higher in PTA recipients who had not been selected to be studied with CCT than those that were (117±32 vs 78±13 mL/min). By 12 months post‐PTA, the CrCl was no longer different between the groups selected to be screened with CCT and those that were not.
Conclusions: CCT may help predict risk for short‐term changes in renal function (<18 months) in response to CsA. CCT may be most helpful in candidates for PTA with borderline renal insufficiency (60–80 mL/min).