Long-term glomerular filtration rate in liver allograft recipients according to the type of calcineurin inhibitors.
The calcineurin inhibitors (CNI) cyclosporine micro emulsion (CyA-ME) and tacrolimus (Tac) both display renal and vascular toxicities. We undertook a single-center retrospective study among 149 surviving liver transplant recipients. The primary outcome was kidney function over 10 years posttransplant, evaluating the glomerular filtration rate (GFR) by the abbreviated Modification of Diet in Renal Disease formula with subsequent Kidney Disease Outcomes Quality Initiative staging. The secondary outcomes included correlations between CNI trough levels (C0), GFR, and items of cardiovascular toxicity. At 1 and 5 years, the mean GFRs were 74.2 and 76.9 mL/min/1.73 m(2) under Tac versus 62.8 and 66.0 mL/min/1.73 m(2) under CyA-ME (P < .001). The mean value in favor of Tac was + 10 mL/min/1.73 m(2). Distribution of GFR stages showed more Tac patients at stage 1 or 2 and more at stage 4 or 5 under CyA-ME. There was no significant correlation between CNI-C0 and GFR. Switches between CNI or to mycophenolate mofetil did not show any significant GFR improvement. Patients under CyA-ME displayed significantly higher blood pressures with 3 requiring dialysis versus none under Tac. In conclusion, we observed that liver transplant patients under Tac maintained significantly better renal function with less progression to dialysis as compared with CyA-ME, indicating a lower renal and vascular (lower BP) toxicity.
Service de Transplantation Rénale, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, A2 UMC, 30 avenue de la voie romaine, 06000 Nice, France. o.r.p.niel@free.fr
O R P
OR
Niel
F
F
Berthoux
L
L
Albano
P
P
Dahan
R
R
Aoudia
J
J
Gugenheim
E
E
Cassuto
D000293:Adolescent; D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005526:Food, Formulated; D005919:Glomerular Filtration Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007677:Kidney Function Tests; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D014184:Transplantation, Homologous / Q000502:physiology; D055815:Young Adult
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus