title: Treatment of cyclosporine-related adverse effects by conversion to tacrolimus after liver transplantation.
abstract: BACKGROUND
  Cyclosporine (CsA)-associated side effects include nephrotoxicity, hypertension, neurological disorders, and hyperlipidemia. A considerable share of early and long-term posttransplant morbidity is likely to be drug related.
  
  
  METHODS
  In 31 patients with stable graft function, conversion from CsA to tacrolimus was implemented due to nephrotoxicity (n=19), hypertension (n=9), and neurological disorders (n=8).
  
  
  RESULTS
  Three months after conversion, a response was evident in 26 patients (84%), whereas 5 patients (16%) were nonresponsive. In 13 of 19 patients (68%) suffering from nephrotoxicity, serum creatinine levels decreased significantly from 2.0+/-0.5 mg/dl to 1.5+/-0.4 mg/dl (P<0.005), whereas in 6 of 19 patients (32%) no improvement was observed. Antihypertensive therapy was reduced in six of nine patients and neurological disorders improved in six of eight patients. When analyzing all patients, average levels of cholesterol and triglycerides were significantly lower after conversion when compared with at the time of conversion (P<0.05)
  
  
  CONCLUSIONS
  Conversion to tacrolimus reduced drug-related side effects in the majority of patients, while graft function remained stable. Conversion to tacrolimus may be considered for CsA-related side effects as a potential beneficial approach.
authors.affiliation: Department of Surgery, Virchow Klinikum, Humboldt-University, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Pratschke
authors.forename: R
authors.initials: R
authors.lastname: Neuhaus
authors.forename: S G
authors.initials: SG
authors.lastname: Tullius
authors.forename: G W
authors.initials: GW
authors.lastname: Haller
authors.forename: S
authors.initials: S
authors.lastname: Jonas
authors.forename: T
authors.initials: T
authors.lastname: Steinmueller
authors.forename: W O
authors.initials: WO
authors.lastname: Bechstein
authors.forename: P
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced; D006973:Hypertension / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009422:Nervous System Diseases / Q000139:chemically induced; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine; D016559:Tacrolimus