Decreased incidence of infection after renal transplantation with the use of cyclosporine

Impact of acute rejection therapy on infections and malignancies in renal transplant recipients

BACKGROUND

Infections and malignancies are important causes of mortality and morbidity in renal allograft recipients. Their risk increases with increasing immunosuppression.

METHODS

In an attempt to quantitate the increase in the risk of these complications in association with antirejection therapy, we reviewed the records of all renal allograft recipients of our center transplanted during the cyclosporin era. We sub-divided the patients into three groups based on acute rejection episodes during the first 6 months posttransplant, and the treatment for acute rejection: those who did not develop AR--group 1 (n=168); those who had one or more episodes of acute rejection and were treated with high dose corticosteroids --group 2 (n=169); those who in addition to corticosteroids required cytolytics (OKT3) and/or other drugs--group 3 (n=141).

RESULTS

52% patients in group 1, 71% patients in group 2 and 86% patients in group 3 had one or more episodes of infection during the first 6 months posttransplantation. Relative risk for group 2 and 3 were 1.56 (P=0.0002) and 2.98 (P<0.00001), respectively. Infection/patient rates at 6 months were 0.67, 1.23, and 2.79 in groups 1, 2, and 3 respectively. Groups 1 and 2 had a similar number of cases with squamous and basal cell carcinoma, however, there were few cases with these malignancies in group 3. No case of lymphoma was seen in group 1; there were four cases in group 2 and nine in group 3. There was no significant difference in patient survival in group 1 and 2, however, patients in group 3 had a reduced patient survival (1 vs. 3 P<0.001, 2 vs. 3 P=0.067). Graft survival was best in group 1 and worst in group 3 (1 vs. 2 P<0.05; 1 vs. 3 P<0.00001; 2 vs. 3 P<0.01).

CONCLUSIONS

In renal transplant recipients the risk of infections and lymphoma increases with increasing immunosuppression and hence mortality and morbidity associated with it. When adding a potent immunosuppressive agent to rescue a kidney one needs to consider the serious and at times fatal side effects given the modest beneficial effect on long-term outcome.

Trends in renal disease morbidity and mortality in the United States, 1979 to 1990

Four indices of morbidity and mortality due to seven groups of renal diseases are evaluated in the United States for the period 1979 through 1990. These indices include mortality, hospitalization, doctor's office visits, and prevalence. Age-adjusted and age-specific rates are calculated. Estimates are provided for racial-, ethnic-, and gender-specific subpopulations. The burden of some diseases had decreased, especially renal infections. Most indices of the burden of diabetes with renal involvement and hypertensive renal disease have increased, especially among segments of the population that are growing. For many groups of disorders examined, men have experienced an increasing burden of disease over the 12 years evaluated. These data support current trends in renal failure and serve to generate hypotheses regarding renal disease patterns. The magnitude of the burden of renal disease and the trends toward increasing rates indicate that renal disease is a large and growing clinical and public health problem. Major improvements are needed in the range and accuracy of diagnosis and of reporting renal-related conditions, and additional resources need to be brought to the problem of renal-related morbidity. This is a US government work. There are no restrictions on its use.