Long-term use of cyclosporine A does not adversely impact on clinical outcomes following renal transplantation.

The present review summarizes thirteen selected studies addressing the impact of cyclosporin A (CsA) on long-term outcomes following successful renal transplantation. Together, the data reflect the clinical courses of over 4,000 CsA-treated renal allograft recipients followed from one to ten years from the time of transplantation. Seven of the studies provided historical control data from more than 10,000 patients treated with azathioprine and prednisone. Graft survival beyond one year in CsA-treated recipients was consistently as good as or better than that achieved in the pre-CsA era. Underscoring the graft survival data, severe forms of the afferent arteriolopathy described as pathognomonic for 'CsA nephropathy' have become very uncommon and highly unlikely to be a cause of early or late graft loss. Retrospective analyses of longitudinal changes in aggregate serum creatinine concentrations did not demonstrate any differences in the long-term rate of attrition of allograft function between CsA- and non-CsA-treated patients. Similarly, prospective studies of serial glomerular filtrate rates did not reflect accelerating loss of function in association with long-term CsA use. CsA may be used for up to 10 years following successful renal transplantation without jeopardizing clinical outcomes. Graft arteriopathy (that is, chronic rejection), not progressive nephrotoxicity, is the dominant obstacle to achieving more uniformly successful long-term graft survival in the CsA era.