title: Long-term comparison of tacrolimus- and cyclosporine-induced nephrotoxicity in pediatric heart-transplant recipients.
abstract: Nephrotoxicity is an adverse effect of cyclosporine and tacrolimus. Studies comparing their long-term nephrotoxicities are lacking. This study evaluates the nephrotoxicity of these agents over a 7-year period following heart transplantation. Pediatric heart-transplant recipients receiving cyclosporine or tacrolimus as primary immunosuppression were evaluated at two centers from 1982 to 1998. Data collected included serum creatinine, height and weight prior to transplantation, at 1 and 6 months and 1 years post transplantation, and at yearly intervals thereafter. Creatinine clearance was calculated and compared between the two groups. Glomerular filtration rate was measured using Tc-99m diethylenetriaminepentacetic acid. In total, 123 patients were evaluated. Demographic data of the two groups were comparable. Creatinine clearance demonstrated a steady decline. This decline did not differ statistically between the two groups: tacrolimus 98.9 and 90.7mL/min/1.73 m2 at 1 month and 5 years, respectively; cyclosporine 110.7 and 81.7 mL/min/ 1.73 m2 at 1 month and 5 years, respectively. Four patients developed end-stage renal failure. Calculated creatinine clearance consistently overestimated glomerular filtration rate, the latter being greater than 2 standard deviations below the mean normal in 38% of patients. We conclude that the nephrotoxicities of tacrolimus and cyclosporine are comparable over the medium- to long-term in pediatric heart-transplant recipients.
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: English
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Pophal
authors.forename: Silviu-Alin
authors.initials: SA
authors.lastname: Bacanu
authors.forename: Jay
authors.initials: J
authors.lastname: Fricker
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Boyle
authors.forename: Demetrius
authors.initials: D
authors.lastname: Ellis
authors.forename: Kelly
authors.initials: K
authors.lastname: Harker
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
authors.forename: Susan A
authors.initials: SA
authors.lastname: Miller
authors.forename: Yuk M
authors.initials: YM
authors.lastname: Law
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.forename: Steven A
authors.initials: SA
authors.lastname: Webber
mesh_terms: D002648:Child; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007674:Kidney Diseases / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus