Oral cyclosporine but not tacrolimus reduces renal transplant blood flow.
BACKGROUND
Calcineurin inhibitors are important immunosuppressive agents, but cause nephrotoxicity.


METHODS
Instantaneous intra-renal transplant hemodynamics were assessed in 22 patients using quantitative cineloop color Doppler imaging after dosing with microemulsion cyclosporine (CSA) or tacrolimus (TAC).


RESULTS
CSA dosing resulted in renal hypoperfusion, with a mean relative reduction of 43%+/-20% (range 22-76%) in maximal fractional area (MFA) of color pixels to nadir, compared to baseline. The mean effect occurred 1.1+/-0.9 hr (median 1 hr) after CSA dosing and was abrogated by calcium channel blockers (P <0.05). The main renal artery velocities, resistive index and small vessel perfusion were unchanged, suggestive of medium-sized arteries mediated vasoconstriction. In contrast, TAC did not alter renal vascularity (2.3+/-4.0% absolute reduction of MFA color pixels vs. 10.7+/-6.5% with CSA, P <0.01).


CONCLUSIONS
CSA, but not TAC, induces phasic hypoperfusion of variable severity within small to medium sized intra-renal arteries soon after dosing, mitigated by calcium channel blockade.
Nankivell
Brian J
BJ
Department of Renal Medicine, University of Sydney, Westmead Hospital, Sydney, NSW, Australia. Brian_Nankivell@wsahs.nsw.gov.au
Chapman
Jeremy R
JR
Bonovas
George
G
Gruenewald
Simon M
SM
D000284:Administration, Oral; D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000187:drug effects; D012079:Renal Circulation / Q000187:drug effects*; D016559:Tacrolimus / Q000008:administration & dosage*
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus