Conversion from Cyclosporine/Azathioprine to Tacrolimus/mycophenolate mofetil in patients with allograft dysfunction and cyclosporine-induced side effects

Mirosław Banasik*, Maria Boratyńska, Krzysztof Letachowicz, Oleksandra Vakulenko, Wojciech Weyde, Wojciech Polak, Dariusz Patrzałek, Marian Klinger

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)221-227
Number of pages7
JournalAdvances in Clinical and Experimental Medicine
Volume16
Issue number2
Publication statusPublished - 2007
Externally publishedYes

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