Long-term Effect of Prostaglandin E Analog(Misoprostol) on Blood Pressure, Cyclosporine Dosage and Allograft Function

Shin, Young Shin; Yang, Chul Woo; Park, Chul Whee; Jin, Dong Chan; Kim, Yong Soo; Kim, Suk Young; Choi, Euy Jin; Chang, Yoon Sik; Bang, Byung Kee

Abstract

Prostaglandin(PG) E has been shown to affect renal function by influencing renal blood flow and perfusion pressure and to have immunosuppressive properties. Positive effects of PG-E on kidney allograft hemodynamics and function have previously been, but not without controversy. This study was therfore designed to evaluate the long-term effect of misoprostol on blood pressure, CsA level, graft survival, renal function and histological change in first- time renal transplant recipients treated with cyclosporine. Eighty kidney transplant(KT) recipients were randomly se parated into three groups according to the duration of misoprostol treatment. Group C(n=50) was control; group M1(n=13) recieved misoprostol for less than 6 months and group M2(n=17) for more than 6 months after KT. The results were as follows. 1)Serum CsA levels at 24 months after KT were not significantly different among the three groups [groupC 167+/-58ng/ml; group M 163+/-75ng/ml (group M1 171+/-70ng/ml, group M2 155+/-81ng/ml)]. Group M2 required higher dosage of CsA than group C or M1 to maintain the proper serum levels (group M2 4.27+/-1.07mg/kg/day vs. group C 4.04+/-0.90mg/ kg/day or group M1 4.08+/-1.03mg/kg/day). But these results were not statistically significant. 2) Mean arterial pressures at 24 months after KT were not different among the groups[group C 101+/-11 mmHg; group M 103+/-10mmHg(group M1 108+/-11 mmHg, group M2 100+/-7mmHg)]. 3) Incidence of acute rejection was no different between group C(10 cases; 20%) and group M(12 cases; 40%). 4) Serum creatinine levels at 24 months after KT were not significantly different among the groups [group C 1.30+/-0.37mg/dl; group M 1.43+/-0.41mg/dl (group M1 1.51+/-0.47mg/dl, group M2 1.36+/-0.37mg/ dl)]. 5) Routine biopsy of transplanted kidney performed at 2 weeks after KT showed more abnormal findings in group C(9 cases; 49%) than group M(4 cases; 28.5%), but there was no statistical significance. In conclusion, long-term misoprostol treatment in renal transplant recipients was not effective in preventing the acute rejection, maintaining the renal fucntion, and decreasing blood pressure. Still, studies in patients receiving CsA are needed to determine the effect of misoprostol in CsA bioavaility and the histologic change of graft kidney.