Tacrolimus as secondary intervention vs. cyclosporine continuation in patients at risk for chronic renal allograft failure

Thomas Waid, Edward Alfrey, Laura L Mulloy, Faud S. Shihab, David Conti, Richard Freeman, Angelo M. de Mattos, Stephen C. Jensik, Stanley Jordan, George C. Francos, David Van Buren, Larry Chan, Robert W. Steiner, Giacomo Basadonna, Karl Brinker, Steven Steinberg, Arthur J. Matas, Anne L. King, Bertram L. Kasiske, David J. CohenDavid Surer, Sharon Inokuchi, John D. Pirsch, Jonathan S. Bromberg, Matthew R. Weir, Stuart M. Greenstein, Stephen J. Tomlanovich, Robert Mendez, Lawrence Kahana, Alice K. Henning, M. Roy First, William E. Fitzsimmons, Kim Salm, Diane Tolzman

Research output: Contribution to journalReview article

17 Scopus citations

Abstract

Background: Chronic renal allograft failure (CRAF) is the leading cause of graft loss post-renal transplantation. This study evaluated the efficacy and safety of tacrolimus as secondary intervention in cyclosporine-treated kidney transplantation patients with impaired allograft function as indicated by elevated serum creatinine (SCr) levels. Methods: Patients receiving cyclosporine-based immunosuppression who had an elevated SCr at least 3 months post-renal transplantation were enrolled. Treatment allocation was 2:1 to switch to tacrolimus or continue cyclosporine. This analysis was performed after 2 yr; patients will be followed for an additional 3 yr. Results: There were 186 enrolled and evaluable patients. On baseline biopsy, 90% of patients had chronic allograft nephropathy. Baseline median SCr was 2.5 mg/dL in both treatment groups. For patients with graft function at month 24, SCr had decreased to 2.3 mg/dL in the tacrolimus-treated patients and increased to 2.6 mg/dL in the cyclosporine-treated patients (p = 0.01). Acute rejection occurred in 4.8% of tacrolimus-treated patients and 5.0% of cyclosporine-treated patients during follow-up. Two-year allograft survival was comparable between groups (tacrolimus 69%, cyclosporine 67%; p = 0.70). Tacrolimus-treated patients had significantly lower cholesterol and low-density lipoprotein levels and also had fewer new-onset infections. Cardiac conditions developed in significantly fewer tacrolimus-treated patients (5.6%) than cyclosporine-treated patients (24.3%; p = 0.004). Glucose levels and the incidences of new-onset diabetes and new-onset hyperglycemia did not differ between treatment groups. Conclusions: Conversion from cyclosporine to tacrolimus results in improved renal function and lipid profiles, and significantly fewer cardiovascular events with no differences in the incidence of acute rejection or new-onset hyperglycemia.

Original languageEnglish (US)
Pages (from-to)573-580
Number of pages8
JournalClinical Transplantation
Volume19
Issue number5
DOIs
StatePublished - Oct 2005

Keywords

  • Cyclosporine
  • Graft rejection
  • Renal transplantation
  • Tacrolimus

ASJC Scopus subject areas

  • Transplantation

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    Waid, T., Alfrey, E., Mulloy, L. L., Shihab, F. S., Conti, D., Freeman, R., de Mattos, A. M., Jensik, S. C., Jordan, S., Francos, G. C., Van Buren, D., Chan, L., Steiner, R. W., Basadonna, G., Brinker, K., Steinberg, S., Matas, A. J., King, A. L., Kasiske, B. L., ... Tolzman, D. (2005). Tacrolimus as secondary intervention vs. cyclosporine continuation in patients at risk for chronic renal allograft failure. Clinical Transplantation, 19(5), 573-580. https://doi.org/10.1111/j.1399-0012.2005.00389.x