Paired kidney analysis of tacrolimus and cyclosporine microemulsion-based therapy in Chinese cadaveric renal transplant recipients.
Few studies used paired kidneys for comparison between tacrolimus and cyclosporine in renal transplantation. Most of the published data used whole blood trough levels for drug monitoring. However, the use of limited sampling strategy and abbreviated formula to estimate the 12-h area under concentration-time curve (AUC(0-12)) allowed better prediction of drug exposure. Sixty-six first cadaveric renal transplant recipients receiving paired kidneys were randomized to receive either tacrolimus-based (n = 33) or cyclosporine microemulsion (Neoral)-based therapies (n = 33). Abbreviated AUC(0-12) was used for drug monitoring and dose titration. Mean follow-up duration was 2.8 +/- 2 years. The patient and graft survival were comparable. Fewer incidence of acute rejection was observed in tacrolimus group (15% vs. 27.3%) though the difference was not significant (P = 0.23). The absolute value and the rate of decline of creatinine clearance were both significantly better in tacrolimus-treated patients. Prevalence of hypertension, post-transplant diabetes mellitus, infection, and malignancy were similar in both groups. Prevalence of hypercholesterolemia (11/33 vs. 4/33) and gum hypertrophy (6/33 vs. 1/33) was more common in cyclosporine-treated patients (P = 0.04 in both parameters). This was the first prospective, randomized study with paired kidney analysis showing the renal function was significantly better in tacrolimus-treated patients than in cyclosporine-treated patients.
Cheung
Chi Yuen
CY
Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China. simoncycheung@gmail.com
Wong
Kim Ming
KM
Chan
Hoi Wong
HW
Liu
Yan Lun
YL
Chan
Yiu Han
YH
Wong
Ho Sing
HS
Chak
Wai Leung
WL
Choi
Koon Shing
KS
Chau
Ka Foon
KF
Li
Chun Sang
CS
D000208:Acute Disease; D000328:Adult; D002681:China / Q000453:epidemiology; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D004655:Emulsions; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D006937:Hypercholesterolemia / Q000209:etiology; D006973:Hypertension / Q000209:etiology; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects
D004655:Emulsions; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus