Study: Immunosuppressive Drugs Ultimately Damage Transplanted Kidney

The principal immunosuppressive drugs taken by kidney transplant recipients, cyclosporine and Prograf, ultimately cause progressive damage to the new kidney that eventually may lead to failure of the new organ, according to Australian researchers.

Reporting in the New England Journal of Medicine, the researchers said they evaluated the natural history of chronic allograft nephropathy over the course of 10 years in 120 diabetics, all but one of whom had received kidney–pancreas transplants.

The transplant recipients were a mean age of 38.2 years at the time of their transplantation and more than half were men.

Overall, the researchers reported that 84.4 percent of the patients were alive at the end of ten years, with the transplanted kidney still functioning in 95.2 percent of the survivors.

But they reported that a decade of the use of calcineurin inhibitors -- in this case cyclosporine -- to prevent rejection had led to "almost universal" chronic allograft nephropathy even in transplanted kidneys that had excellent early performance.

"By 10 years, severe chronic allograft nephropathy was present in 58.4 percent of patients, with sclerosis in 37.3 percent of glomeruli," the researchers reported. "Tubulointerstitial and glomerular damage, once established, was irreversible, resulting in declining renal function and graft failure."

"The high prevalence of late nephrotoxicity, the irreversibility of progressive glomerulosclerosis, and its contribution to chronic allograft nephropathy suggest that calcineurin inhibitors are unsuitable as long-term immunosuppressive agents for kidney transplantation," the researchers concluded.

Other Sources: New England Journal of Medicine