Improved cardiovascular risk profile and renal function in renal transplant patients after randomized conversion from cyclosporine to tacrolimus.
Cyclosporine is considered to contribute to the high cardiovascular morbidity and mortality in patients after renal transplantation. Tacrolimus may be more favorable in this respect, but controlled data are scarce. In this prospective randomized study in 124 stable renal transplant patients, the effects of conversion from cyclosporine to tacrolimus on cardiovascular risk factors and renal function were investigated. Follow-up was 6 mo. Statistical analysis was performed by ANOVA for repeated measurements. The serum creatinine level decreased from 137 +/- 30 micromol/L to 131 +/- 29 micromol/L (P < 0.01). Three months after conversion from cyclosporine to tacrolimus, mean BP significantly decreased from 104 +/- 13 to 99 +/- 12 mmHg (P < 0.001). Serum LDL cholesterol decreased from 3.48 +/- 0.80 to 3.11 +/- 0.74 mmol/L (P < 0.001,) and serum apolipoprotein B decreased from 1018 +/- 189 to 935 +/- 174 mg/L (P < 0.001). Serum triglycerides decreased from 2.11 +/- 1.12 to 1.72 +/- 0.94 mmol/L (P < 0.001). In addition, both rate and extent of LDL oxidation were reduced. The fibrinogen level decreased from 3638 +/- 857 to 3417 +/- 751 mg/L (P < 0.05). Plasma homocysteine concentration did not change. Three months after conversion, plasma fasting glucose level temporarily increased from 5.4 +/- 1.3 mmol/L to 5.8 +/- 1.9 mmol/L (P < 0.05). Conversion to tacrolimus resulted in a significant reduction of the Framingham risk score. In conclusion, conversion from cyclosporine to tacrolimus in stable renal transplant patients has a beneficial effect on renal function, BP, serum concentration and atherogenic properties of serum lipids, and fibrinogen.
Artz
Marika A
MA
Department of Nephrology, University Medical Center of Nijmegen, PO Box 9101, 6500 HB Nijmegen, the Netherlands. m.artz@nier.umcn.nl
Boots
Johannes M M
JM
Ligtenberg
Gerry
G
Roodnat
Joke I
JI
Christiaans
Maarten H L
MH
Vos
Pieter F
PF
Blom
Henk J
HJ
Sweep
Fred C G J
FC
Demacker
Pierre N M
PN
Hilbrands
Luuk B
LB
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001055:Apolipoproteins B / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001835:Body Weight; D002319:Cardiovascular System / Q000187:drug effects*; D002784:Cholesterol / Q000378:metabolism; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects*; D016030:Kidney Transplantation; D008077:Lipoproteins, LDL / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use*; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
D001055:Apolipoproteins B; D001786:Blood Glucose; D007166:Immunosuppressive Agents; D008077:Lipoproteins, LDL; D014280:Triglycerides; D016572:Cyclosporine; D005340:Fibrinogen; D002784:Cholesterol; D010100:Oxygen; D016559:Tacrolimus