title: Early conversion from cyclosporine to tacrolimus increases renal graft function in chronic allograft nephropathy at BANFF stages I and II.
abstract: Switching from cyclosporine to tacrolimus without steroid pulse was suggested as a therapeutic option in chronic allograft nephropathy (CAN). Thirty-one renal transplant recipients with CAN were prospectively converted from cyclosporine to tacrolimus (group A), in parallel 31 matched cyclosporin A (CsA) patients (group B) without CAN were followed up for 30 months. In six matching patients of groups A and B inulin and para-aminohippurate (PAH)-clearances and mycophenolate were measured over a span of 3 months. Transplant biopsies of group A were scored according to BANFF. While group A presented with transplant dysfunction compared with group B before switching (2.7 +/- 0.16 mg/dl vs. 1.7 +/- 0.09 mg/dl; P < 0.001), transplant function was equal 30 months later: it ameliorated in group A (2.0 +/- 0.18 mg/dl vs. 2.7 +/- 0.16 mg/dl; P < 0.001) and decreased in group B (1.9 +/- 0.13 mg/dl vs. 1.7 +/- 0.09 mg/dl, P < 0.05). Especially, patients with biopsy scores I and II according to BANFF benefited from tacrolimus. Within 3 months, mycophenolate acid (MPA) levels increased under tacrolimus (P < 0.05) whereas inulin and PAH-clearances remained unchanged. At switching, antihypertensive treatment was more intense in group B, but this difference evened out. Adverse side effects were more frequent under tacrolimus. Patients with mild to moderate CAN significantly benefited from switching to tacrolimus. Increased MPA-levels under tacrolimus might have contributed to this effect.
authors.affiliation: Department for Nephrology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Marcard
authors.forename: Katrin
authors.initials: K
authors.lastname: Ivens
authors.forename: Bernd
authors.initials: B
authors.lastname: Grabensee
authors.forename: Reinhart
authors.initials: R
authors.lastname: Willers
authors.forename: Udo
authors.initials: U
authors.lastname: Helmchen
authors.forename: Lars Christian
authors.initials: LC
authors.lastname: Rump
authors.forename: Cornelia
authors.initials: C
authors.lastname: Blume
mesh_terms: D000328:Adult; D001706:Biopsy; D001794:Blood Pressure; D002908:Chronic Disease; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000145:classification / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016559:Tacrolimus / Q000627:therapeutic use*; D014184:Transplantation, Homologous / Q000276:immunology / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus