Randomized prospective study of the evolution of renal function depending on the anticalcineurin used.
BACKGROUND
Renal failure is one of the primary medium- to long-term morbidities in heart transplant (HT) recipients. To a great extent, this renal deterioration is associated with calcineurin inhibitors, primarily cyclosporine A (CsA). It has been suggested that tacrolimus provides better renal function in these patients. We assessed the medium-term evolution of renal function depending on the calcineurin inhibitor used after HT.


METHODS
We assessed 40 consecutive HT recipients over one year. Patients were randomized to receive CsA (n = 20) or tacrolimus (n = 20) in combination with mycophenolate mofetil (1 g/12 h) and deflazacort in decreasing dosages. We analyzed demographic variables before HT, creatinine values before and six months after HT and incidence of acute rejection.


RESULTS
No demographic, clinical, or analytical differences were observed were between the two groups before HT. Repeated measures analysis of variance of creatinine values showed no significant differences between the two groups (P = .98). Furthermore, no differences were observed in either the incidence of rejection (P = .02) or rejection-free survival (P = .14).


CONCLUSIONS
There seems to be no difference in efficacy profile and renal tolerability between CsA and tacrolimus therapy during the first months after HT.
Moro
J A
JA
Fundación Investigación, Cardiología, La Fe University Hospital, Valencia, Spain; Unidad Insuficiencia Cardiaca y Trasplante, Cardiología, La Fe University Hospital, Valencia, Spain. moro@uv.es
Almenar Bonet
L
L
Martínez-Dolz
L
L
Raso
R
R
Sánchez-Lázaro
I
I
Agüero
J
J
Salvador
Antonio
A
D000368:Aged; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006331:Heart Diseases / Q000145:classification / Q000601:surgery; D016027:Heart Transplantation / Q000276:immunology* / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011282:Pregnenediones / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D011282:Pregnenediones; D016572:Cyclosporine; D003404:Creatinine; D009173:Mycophenolic Acid; C021988:deflazacort; D016559:Tacrolimus