The effect of cyclosporine on native renal function in non-uremic diabetic recipients of pancreas transplants.

In order to assess the nephrotoxic effect of cyclosporine on native kidneys in pancreas transplant recipients, serum creatinine and creatinine clearance levels were determined before and serially after pancreas transplantation alone in 33 non-uremic Type I diabetic patients. The mean serum creatinine level before transplant was 1.0 +/- 0.3 mg/dl, and the values at 2 weeks, 6 months, 1 to 2 years, and greater than 2 years after transplant were, respectively, 1.5 +/- 0.6, 1.4 +/- 0.4, 1.4 +/- 0.5, and 1.5 +/- 0.2 mg/dl. Mean creatinine clearance level before transplant was 90 +/- 34 ml/min, and the values at the corresponding time points were 55 +/- 23, 62 +/- 22, 58 +/- 13, and 63 +/- 16. Thus, the mean changes in both parameters were approximately 50% in the immediate period after transplant, and there was no additional deterioration by these measures of renal function. The changes were somewhat greater than those reported in newly diagnosed diabetic patients receiving cyclosporine for immunotherapy, but all of the subjects had histologic evidence of diabetic nephropathy at the time of transplant. Although the stabilization of renal function is encouraging, damage to the kidneys may be silent and serial renal biopsies are needed to allow full assessment of the impact of cyclosporine on renal pathologic conditions.