title: Increased early rejection rate after conversion from tacrolimus in kidney and pancreas transplantation.
abstract: BACKGROUND
  A successful immunosuppression regimen for combined kidney and pancreas transplants is tacrolimus, mycophenolate mofetil, and prednisone. However, not all patients tolerate these immunosuppressants especially tacrolimus.
  
  
  OBJECTIVE
  To evaluate the efficacy of cyclosporine as a rescue agent for tacrolimus toxicity in combined kidney and pancreas transplants.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Single center.
  
  
  METHODS
  Thirty-five combined kidney and pancreas transplants were performed between July 1994 and January 1999. All patients were insulin dependent diabetics with end-stage renal disease. Twenty-eight (mean age: 36 years and 57% female) were available with at least 12 month follow-up.
  
  
  METHODS
  Conversion to cyclosporine following renal (biopsy proven) or pancreatic dysfunction.
  
  
  METHODS
  Toxicity, rejection rate, and patient/transplant organ survival.
  
  
  RESULTS
  Nineteen transplant recipients (68%) were continuously maintained on tacrolimus while nine (32%) required conversion to cyclosporine 75 +/- 20 days post-transplant. Reasons for conversion included: hyperglycemia (n=2), hemolytic-uremic syndrome (n=1), and severe tacrolimus nephrotoxicity (n=6). By 12 months post-transplant, the 19 patients maintained on tacrolimus had 5 rejections (26%). Three of the 9 patients (33%) converted to cyclosporine had an acute rejection prior to conversion. Seven of these 9 patients (78%; P=0.017 vs. patients maintained on tacrolimus) had rejections an average of 25 +/- 4 days post-conversion. Four of the 7 patients had no previous rejections prior to conversion. In spite of increased rejections, the 1- and 2-year patient/graft survivals were unchanged by converting.
  
  
  CONCLUSIONS
  Converting to cyclosporine from tacrolimus was associated with an increased risk of acute rejection especially within the first 30 days post conversion.
authors.affiliation: Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. baronegary@uams.edu
authors.forename: Gary W
authors.initials: GW
authors.lastname: Barone
authors.forename: Beverley L
authors.initials: BL
authors.lastname: Ketel
authors.forename: Sameh R
authors.initials: SR
authors.lastname: Abul-Ezz
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Lightfoot
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D004361:Drug Tolerance; D005260:Female; D006084:Graft Rejection / Q000139:chemically induced / Q000378:metabolism*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus