99mTc-DTPA and 131I-hippuran findings in liver transplant recipients treated with cyclosporin A

Abstract

The effects of cyclosporin A (CyA), an immunosuppressive agent that is potentially nephrotoxic, on the kidneys of 9 liver transplant recipients were studied with serial 99mTc-DTPA and 131I-hippuran scans. In addition, renal function was determined by measuring serum creatinine levels during the second postoperative week in the 9 unselected CyA-treated patients and, retrospectively, in a control group of 29 liver transplant recipients who had not been treated with CyA and who were selected because they had survived for at least 3 months postoperatively. The early postoperative creatinine level was significantly greater in the CyA group. Eight of the 9 CyA patients showed imaging abnormalities in all preoperative and postoperative studies. Five of the 8 patients showed a pattern similar to that of acute tubular necrosis (relatively preserved perfusion) in at least one study. Lowering the dosage of CyA permitted the continuation of therapy, and all 9 patients are alive after 8 to 14 months.

Figure 1

Two ^99mTc-DTPA studies, pretransplantation and posttransplantation, are shown. The first study is normal (Grade 1 perfusion, clearance, and parenchymal transit time). The second study, after 21 days of cyclosporin A immunosuppressive therapy, shows a mild-to-moderate decrease in perfusion (Grade 2) and a severe decrease in clearance (Grade 4).