Treatment of cyclosporine-related adverse effects by conversion to tacrolimus after liver transplantation.
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.
Pratschke
J
J
Department of Surgery, Virchow Klinikum, Humboldt-University, Berlin, Germany.
Neuhaus
R
R
Tullius
S G
SG
Haller
G W
GW
Jonas
S
S
Steinmueller
T
T
Bechstein
W O
WO
Neuhaus
P
P
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
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine; D016559:Tacrolimus