TY - JOUR
T1 - Conversion from Cyclosporine/Azathioprine to Tacrolimus/mycophenolate mofetil in patients with allograft dysfunction and cyclosporine-induced side effects
AU - Banasik, Mirosław
AU - Boratyńska, Maria
AU - Letachowicz, Krzysztof
AU - Vakulenko, Oleksandra
AU - Weyde, Wojciech
AU - Polak, Wojciech
AU - Patrzałek, Dariusz
AU - Klinger, Marian
PY - 2007
Y1 - 2007
N2 - Background. Conversion from cyclosporine (CsA) to tacrolimus (Tac) can be a strategy in kidney transplant patients with acute rejection and deterioration of renal function. Cyclosporine-induced side effects can also suggest such a procedure. Objectives. To examine the influence of conversion from CsA/azathioprine to Tac/mycophenolate mofetil (MMF) on renal graft function, survival, and cyclosporine-induced side effects. Material and Methods. A total of 88 patients were converted to Tac/MMF for the following reasons: 55 patients (group I) in whom acute rejection had not resolved, 26 patients (group II) with chronic allograft dysfunction, and 7 patients (group III) with gingival hyperplasia or hyperlipidemia. Results. In group I, acute rejection was treated with methylprednisolone and additionally with ATG in 10 patients. The conversion was performed 4.4 ± 5.2 months after transplantation. Serum creatinine dropped from 3.02 ± 1.6 mg/dl before conversion to 2.08 ± 0.8 (p = 0.0002) after 6 months 2.2 ± 1.1 (p = 0.003) after 12 months, and 2.3 ± 1.4 (p = 0.04) after 24 months. The decline in renal function caused loss of graft in 5 patients 1 year after conversion (graft survival: 91%), in 7 after 2 years, and in 3 after 3 years (graft survival: 71%). Group II patients were converted 51.1 ± 39.7 months after transplantation and exhibited deterioration of renal function: creatinine level rose from 2.7 ± 0.6 mg/dl before conversion to 3.5 ± 1.3 mg/dl after one year (p < 0.05). Twelve patients lost their grafts one year after conversion (graft survival: 53.8%). Group III patients were converted 31.8 ± 28 months after transplantation and had a mean serum creatinine level of 1.1 ± 0.6 mg/dl, which did not change with conversion. The side effects of cyclosporine ameliorated. In all the patients the cholesterol level decreased from 6.06 ± 1.7 mM to 5.15 ± 1.2 mM (p = 0.0007) and triglyceride level from 2.45 ± 1.7 mM to 1.91 ± 1.0 mM (p < 0.05) 12 months after conversion. Significant changes in blood pressure were not observed after conversion. Conclusions. The patients with acute rejection in whom antirejection therapy did not provide total resolution benefited from the conversion to tacrolimus/MMF. However, it failed to stop progressive chronic graft nephropathy. The conversion allowed regression of cyclosporine-induced side effects. Hyperlipidemia was also significantly ameliorated.
AB - Background. Conversion from cyclosporine (CsA) to tacrolimus (Tac) can be a strategy in kidney transplant patients with acute rejection and deterioration of renal function. Cyclosporine-induced side effects can also suggest such a procedure. Objectives. To examine the influence of conversion from CsA/azathioprine to Tac/mycophenolate mofetil (MMF) on renal graft function, survival, and cyclosporine-induced side effects. Material and Methods. A total of 88 patients were converted to Tac/MMF for the following reasons: 55 patients (group I) in whom acute rejection had not resolved, 26 patients (group II) with chronic allograft dysfunction, and 7 patients (group III) with gingival hyperplasia or hyperlipidemia. Results. In group I, acute rejection was treated with methylprednisolone and additionally with ATG in 10 patients. The conversion was performed 4.4 ± 5.2 months after transplantation. Serum creatinine dropped from 3.02 ± 1.6 mg/dl before conversion to 2.08 ± 0.8 (p = 0.0002) after 6 months 2.2 ± 1.1 (p = 0.003) after 12 months, and 2.3 ± 1.4 (p = 0.04) after 24 months. The decline in renal function caused loss of graft in 5 patients 1 year after conversion (graft survival: 91%), in 7 after 2 years, and in 3 after 3 years (graft survival: 71%). Group II patients were converted 51.1 ± 39.7 months after transplantation and exhibited deterioration of renal function: creatinine level rose from 2.7 ± 0.6 mg/dl before conversion to 3.5 ± 1.3 mg/dl after one year (p < 0.05). Twelve patients lost their grafts one year after conversion (graft survival: 53.8%). Group III patients were converted 31.8 ± 28 months after transplantation and had a mean serum creatinine level of 1.1 ± 0.6 mg/dl, which did not change with conversion. The side effects of cyclosporine ameliorated. In all the patients the cholesterol level decreased from 6.06 ± 1.7 mM to 5.15 ± 1.2 mM (p = 0.0007) and triglyceride level from 2.45 ± 1.7 mM to 1.91 ± 1.0 mM (p < 0.05) 12 months after conversion. Significant changes in blood pressure were not observed after conversion. Conclusions. The patients with acute rejection in whom antirejection therapy did not provide total resolution benefited from the conversion to tacrolimus/MMF. However, it failed to stop progressive chronic graft nephropathy. The conversion allowed regression of cyclosporine-induced side effects. Hyperlipidemia was also significantly ameliorated.
UR - http://www.scopus.com/inward/record.url?scp=34250168365&partnerID=8YFLogxK
M3 - Article
AN - SCOPUS:34250168365
SN - 1230-025X
VL - 16
SP - 221
EP - 227
JO - Advances in Clinical and Experimental Medicine
JF - Advances in Clinical and Experimental Medicine
IS - 2
ER -