Post-operative conversion from cyclosporine to tacrolimus in heart transplantation: a single-center experience.
BACKGROUND
Tacrolimus is a potent calcineurin inhibitor that was introduced to heart transplantation in the early 1990s. The side-effect profile of tacrolimus is more favorable than that of cyclosporine and some reports have suggested an advantage of tacrolimus in the treatment of rejection. The present study was undertaken to determine whether a late conversion to tacrolimus affords these benefits to heart transplant recipients.


METHODS
Charts from 109 patients who underwent conversion from cyclosporine to tacrolimus for recurrent rejection or adverse effects were retrospectively reviewed.


RESULTS
During the year after conversion to tacrolimus, there was a significant decrease in treated rejection episodes. Conversion to tacrolimus rapidly resulted in an improved lipid profile. Two years after conversion blood pressure was significantly reduced. Apart from rejection, these benefits were found mainly among individuals converted to tacrolimus within 1 year of heart transplantation.


CONCLUSIONS
Conversion from cyclosporine to tacrolimus is safe and results in a more favorable risk factor profile. However, most of the benefits are seen in individuals converted within 1 year of transplantation.
Cantin
Bernard
B
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA. clajoie@sympatico.ca
Kwok
Bernard W K
BW
Shiba
Nobuyuki
N
Valantine
Hannah A
HA
Hunt
Sharon A
SA
Chan
Michael C Y
MC
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D002140:California / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D003971:Diastole / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000401:mortality; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000628:therapy; D011182:Postoperative Care; D011183:Postoperative Complications / Q000188:drug therapy / Q000401:mortality; D012008:Recurrence; D013256:Steroids / Q000627:therapeutic use; D016019:Survival Analysis; D013599:Systole / Q000187:drug effects; D016559:Tacrolimus / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D002784:Cholesterol; D003404:Creatinine; D016559:Tacrolimus