Immunosuppressive regimens in patients with chronic allograft nephropathy / 第三军医大学学报

ABSTRACT

Objective To investigate whether reduced or discontinued calcineurin inhibitor (CNI) can improve the renal functions of renal transplant recipients with chronic allograft nephropathy (CAN). Methods A total of 46 renal transplant recipients with declining graft function and biopsy proven CAN were studied. Within 1～2 weeks, CNI (Cyclosporine A or Tacrolimus ) in 27 recipients (group A) was discontinued or reduced to one third of their original doses, but Azathioprine (Aza) or mycophenolate mofetil (MMF) was increased properly. The doses of CNI in the 19 recipients (group B) were not changed obviously, but Aza or MMF was increased properly. At least 1-year follow-up was performed in all patients. Renal functions were compared between the two groups. The incidence of acute renal graft rejection was calculated in both groups. Results One year later, there were 17 patients (63.0%) with stabilized or improved graft function in group A, and 2 (10.5%) in group B. The difference was significant. The incidences of acute rejection in both groups were not significantly different. Conclusion For some renal transplant recipients with declining graft function and biopsy proven CAN, remarkably reduced or discontinued CNI can stabilize or improve their renal functions. Adjusting the doses of immunosuppressive agents does not increase the risk of acute rejection.