Long-term beneficial effect of tacrolimus conversion on renal transplant recipients.
OBJECTIVE
Acute rejection, chronic allograft nephropathy, and cyclosporine (CsA) toxicity remain serious problems for renal transplant recipients and may lead to graft loss. We retrospectively analyzed 34 patients whose biopsies revealed acute and/or chronic allograft rejection, or CsA nephrotoxicity, and who converted from CsA to tacrolimus.


METHODS
From July 1996 through September 2003, CsA was converted to tacrolimus in 34 renal transplant recipients (26 male, 8 female) with renal biopsy at our hospital. Blood pressure and serum creatinine levels were checked monthly and serum cholesterol, triglyceride, and glutamic-pyruvic transaminase (GPT) levels were checked every three months.


RESULTS
A consistently stable and better function after conversion was obtained in a significant portion (24, 71%) of patients. A statistically significant decline in serum creatinine and an improvement in the glomerular filtration rate were found at 3 m, 6 m, 12 m, 36 m, and 72 m after tacrolimus conversion. In 85.7% (12/14) of patients with acute rejection and in 35.7% (5/14) of patients with chronic allograft nephropathy (concomitant with acute rejection in 5), improved or stabilized graft function was noted. In addition, the systolic blood pressure and diastolic BP dropped significantly (P<0.05), while there was no significant change in cholesterol, triglyceride, and GPT levels.


CONCLUSIONS
The beneficial effect of tacrolimus conversion on patients with acute rejection, chronic allograft nephropathy, or CsA nephrotoxicity was demonstrated in long-term follow up. The improvement in both renal function and blood pressure may be of paramount importance in reducing long-term cardiovascular morbidity and mortality.
Lee
Wen-Chin
WC
Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Lian
Jong-Da
JD
Wu
Ming-Ju
MJ
Cheng
Chi-Hung
CH
Chen
Cheng-Hsu
CH
Shu
Kuo-Hsiung
KH
D000328:Adult; D016009:Chi-Square Distribution; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D016559:Tacrolimus / Q000008:administration & dosage*; D014181:Transplantation Immunology / Q000187:drug effects*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016559:Tacrolimus