A numerical scale comparison of renal transplant recipient experience with and opinions about calcineurin inhibitors.
BACKGROUND
Many studies compare the relative benefits of cyclosporine and tacrolimus with respect to graft and patient outcomes, but comparative renal transplant recipient opinion on calcineurin inhibitor (CI) use has not been directly sought.


METHODS
We administered a confidential clinic-distributed written questionnaire to adult single-organ recipients pertaining to CI use and related physical side effects experienced. Sixteen common immunosuppressive therapy-related side effects were rated on a 1-10 Likert numerical scale, with 1 meaning complete disagreement and 10 complete agreement with their own CI experience. Comparisons were made among recipients on cyclosporine, tacrolimus, and those with a dual drug experience.


RESULTS
The questionnaire was filled by 316 patients. The efficacy of cyclosporine and tacrolimus was considered equivalent (p = 0.99), while the overall side effect profile reported was greater for cyclosporine (p = 0.001). The side effect profile for cyclosporine was greater in the dual group than the cyclosporine-only group (p = 0.01). Cyclosporine was perceived as more difficult to swallow (p = 0.001), nephrotoxic (p = 0.005), and to cause more hypertension (p = 0.04) and hyperlipidemia (p = 0.001), while tacrolimus was perceived to be more neurotoxic (p < 0.0001), but not causing more diabetes (p = 0.64).


CONCLUSIONS
Renal transplant recipients experience fewer and less severe side effects with tacrolimus. Further contemporaneous study of CI preferences in this population is warranted. Transplant centers should consider patient opinion in tailoring their own immunosuppressive strategies and regimens.
Prasad
G V Ramesh
GV
Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ont., Canada. prasadr@smh.toronto.on.ca
Nash
Michelle M
MM
McFarlane
Philip A
PA
Zaltzman
Jeffrey S
JS
D000328:Adult; D001294:Attitude to Health; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000523:psychology; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D011446:Prospective Studies; D012306:Risk; D011795:Surveys and Questionnaires; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D013810:Therapeutic Equivalency; D016312:Treatment Refusal
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus