An association of arterial occlusive disease with cyclosporine therapy after kidney transplantation

Renal transplantation followed by immunosuppression with cyclosporine (whole-blood levels 200-300 micrograms/l) and methylprednisolone (4 mg daily) was performed in a 54-year-old man with chronic glomerulonephritis. Three years later rapidly progressive arterial obstructive disease (peripheral type) developed. Parenteral treatment with prostaglandins, calcium antagonists and nitrates, as well as a lumbar sympathectomy, was unsuccessful so that, in rapid succession, several amputations on upper and lower limbs became necessary. The disease progression was arrested only when azathioprine replaced cyclosporine. Raynaud's phenomenon, present at the time, also disappeared and analgesics were no longer required. Histological examination revealed severe Monckeberg arteriosclerosis and thromboembolic occlusion of the affected vessels. The cyclosporine treatment, especially the hypercoagulability induced by it, and the Monckeberg arteriosclerosis were thought to be significant factors in the pathogenesis of the rapidly progressive arterial disease. It is concluded that, in the presence of progressive arterial obstructive disease occurring under cyclosporine treatment, the replacement by other immunosuppressive agents should be considered.