Conversion from cyclosporine to FK506 in adult liver transplant recipients: a combined North American and European experience.
BACKGROUND
Although cyclosporine (CsA) made clinical liver transplantation possible, side effects and development of rejection have limited its use. In some patients, conversion to tacrolimus has been necessary to abrogate side effects and to preserve allograft function.


METHODS
The results of conversion from CsA to tacrolimus were studied retrospectively in 94 liver allograft recipients from a North American and a European transplant center (Duke University Medical Center, Durham, NC, and Hopital Beaujon, Clichy, France).


RESULTS
Forty-seven of 94 patients (50%) were converted for steroid-resistant acute rejection. Conversion was successful in 91% of these patients, whereas 9% of patients developed chronic rejection. A further nine patients were converted for chronic allograft rejection with positive results in eight of nine grafts. Mean serum bilirubin in these nine patients was 8.7 mg/dl before conversion and 2.1 mg/dl 6 months after conversion (P=0.02). Nine patients were converted due to inability to wean steroid. Of these, six patients remains steroid free 1 year after conversion. Twenty-three patients (24%) were converted for nephrotoxicity with a reduction in serum creatinine from 167+/-36 mmol/L to 119+/-28 mmol/L 1 year after conversion (P=0.006). Eight of 11 patients converted for neurotoxicity improved after conversion. Conversion to tacrolimus had no effect on seizure frequency or memory loss.


CONCLUSIONS
These results suggest that conversion to tacrolimus from CsA is an appropriate paradigm for graft rescue and treatment of a variety of side effects after liver transplant. However, some situations such as memory loss and hypertension may require other strategies.
Selzner
N
N
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Durand
F
F
Bernuau
J
J
Heneghan
M A
MA
Tuttle-Newhall
J E
JE
Belghiti
J
J
Clavien
P A
PA
D000328:Adult; D016572:Cyclosporine / Q000506:poisoning / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000506:poisoning / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000139:chemically induced / Q000188:drug therapy; D008099:Liver / Q000503:physiopathology; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000139:chemically induced / Q000188:drug therapy; D019233:Retreatment; D012189:Retrospective Studies; D016879:Salvage Therapy; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D016559:Tacrolimus