Prognostic factors of long‐term allograft survival in 632 CyA‐treated recipients of a primary renal transplant

. A total of 632 cyclosporin (CyA)‐treated primary renal allograft recipients with a functioning graft at 6 months were retrospectively evaluated for risk factors correlated with long‐term allograft function. Mean follow‐up after the 6th month was 68.4 ± 40.6 months. One hundred twenty‐one of these patients (19 %) were lost: 29 died (23/29 with a functioning graft), 77 of the remaining 92 (83 %) lost their graft because of chronic allograft dysfunction, 9 due to recurrence of glomerulonephritis, 5 due to renal artery thrombosis, and 1 due to chronic CyA toxicity. At univariate analysis, factors correlated with a better renal (R) and pure renal (PR) allograft survival were: dialysis duration of less than 5 years, fewer than 2 rejections within the 6th post‐Tx month, immediate graft function recovery, plasma creatinine below 1.5 mg/dl at the 6th month, age at Tx above 15 years, and receiving a living donor graft. Cox's regression analysis was also performed to obtain relative risks for the same parameters. Long‐term dialysis patients had more frequent late recoveries (P ‐ 0.002) and reductions in therapy (P = 0.01) in order to reduce the side effects of steroids. In young patients receiving an initial oral CyA dose of 17 mg/kg per day, steroids were stopped at the 6th month in order to achieve catch‐up growth: only one such patient lost his graft. In contrast, 72 % of the young patients who lost their grafts received an initial oral CyA dosage of 13 mg/ kg per day. Thus, young patients did worse not because of steroid withdrawal, but because of inadequate initial CyA dosage. These results suggest that although we cannot exclude alloantigen‐independent mechanisms as factors that stimulate progression of chronic allograft dysfunction, it would appear that the initial lesions are induced by events mostly mediated by immunological mechanisms.