New patterns of transplant nephrectomy in the cyclosporine era.

Several significant advances in transplantation during the last decade, among them the introduction of cyclosporine, have greatly altered the management of allograft recipients. To determine the frequency and pattern of transplant nephrectomy (TN) since cyclosporine was introduced in 1984, we reviewed our results from 1968 through 1990. During the 23 year period, 766 renal transplants were performed; 280 before 1984, when cyclosporine was first introduced into routine care and 486 after that time. Of the 280 recipients undergoing transplantation before 1984, 70 underwent TN, whereas only 61 of the 486 recipients in the cyclosporine period have undergone TN (p < 0.01). Comparing the demographics of those who had TN before 1984 with those who had TN in the cyclosporine era shows similarities: the mean age at TN (32 versus 32 years), percent male (66 versus 61), percent black (51 versus 61), percent of TN operations within six months of graft insertion (80 versus 70) and percent perioperative complications (nine versus 11). During the precyclosporine era, TN was performed more frequently in patients who received allografts from cadavers versus living related donors (30 versus 8 percent, p < 0.05), but this difference was eliminated after 1983 (11 versus 13 percent, p = NS). TN was performed more frequently after secondary versus primary transplants in the early (36 versus 23 percent) and later (23 versus 11 percent) time periods (p < 0.05 only for the later time period). It is also noteworthy that the rate of TN decreased significantly for primary and secondary transplants in the later time period. For low risk white patients and higher risk black patients the rate of TN decreased in an identical manner. We conclude that since the introduction of cyclosporine, TN is performed less frequently, the frequency of TN in lower risk (primary white) and higher risk (secondary, black, cadaveric) groups has decreased and TN has been and remains a safe procedure.