Transplant failure?

[cykid]

Hello to all,

I'm 33 and I had received a kidney transplant some 2.5 years ago. It went fine so far; never had a sign of rejection yet. The only issues were about 3 urinary infections, promptly treated with ciprofloxacin (a known nephrotoxic). The kidney was the greatest gift my father could ever offer me, and the compatibility was very high (I look just like my father, and we share the same blood type).
When I got home after the transplant, the creatinine was around 1,2 (it was 14 before the transplant, which has been done preemptively - no dialysis before). Everything went just well till around the Christmas, when my doctor who follows the transplant asked me to stop taking prednisone, which I did. By that time I have been taking 5 mg of prednisone, 2x3 mg Prograf and 2x1g Cellcept/day. As soon as I stopped the prednisone (and I did it slowly, during 1 month with half a pill, then a quarter) I noticed I started to feel bad, tired and so on. I thought "these must be the infamous prednisone withdrawal symptoms), but the creatinine level rose to 1.6, and the prograf level doubled (it was 12 or 14). The blood tests also revealed that the liver started to suffer too, with the transaminases around 4 times higher then the normal values. The doctor asked me to lower the progaf dose, 0.5 mg at a time, till I had reached the level of 1.5mg x 2/day (half the original dose), when the tacrolimus level got back to normal (around 6). That took about 3 months.

Now, my creatinine level had stabilized around 1.5; I can lower it to 1.4 with a drastic  low level proteic diet and lots of water, but there is really no point in doing it. I eat normally, with no salt and very little meat of any kind (only once per week). I also avoid fats (especially cholesterol). Not too much sugar either (my glucose level is always above 100, but under 120).

What I think must happened is that when there was no more prednisone in my body the liver started to get poisoned by the prograf (it refused to metabolize it as the "pacifier" steroid was missing), and the graft must have been damaged by the too-high levels of prograf (which is a known nefrotoxic).

I don't know if I'm right, maybe the transplanted kidney started to show signs of wear? Is this what it looks like? A steady, slow increasing of the creatinine level over the years? Or it's just an abrupt raise when it's "finished"?

And if I'm right, and the graft was affected, did I gain something by getting rid of the prednisone? I know it has nasty effects over the time, but I was only taking a pill of 5 mg/day.

Thank you for reading all of this.

Any thoughts?

[okarol]

You have some good questions and I would ask the transplant team and nephrologist to help you figure out what has happened. The Prograf toxicity is something that they watch carefully and it sounds like that may have contributed, but without a biopsy I wonder if there is anyway to truly know.
I have a friend who received a deceased donor kidney, her creatinine was 2.2 following surgery, and it never went down. Doctors told her the kidney would most likely have a short lifespan. She is now losing the kidney, just over 20 years later. So it's really hard to tell if someone has plateaued or if there is additional graft loss to experience.
Best wishes to you and your kidney (and your fabulous donor, Dad!) My daughter has lost much of her kidney function after 3 years, rejection is the cause, but she has stayed at 4.1 creatinine for 4 months, which was not expected. It could stay here for awhile, or drop quickly, as we know often happens. She has a cold right now, and I worry that even this simple illness could stress out her body, but for now she appears to be stable.

[cykid]

My nephrologist is baffled about this.

The truth is, a kidney it's just a spare part to them. For my it's "my precious". We'll see how it goes in the future.

What is the standard treatment in the case of an urinary infection in your cases? I'm guessing ciprofloxacin has quite negative impact on the kidneys.