Improvement of cardiovascular risk factors and cosmetic side effects in kidney transplant recipients after conversion to tacrolimus.

AIMS Tacrolimus and Cyclosporine A (CyA) are cornerstones in immunosuppressive therapy. Cyclosporine side eff ects include hypertension and hypercholesterolemia both of which may increase the risk of cardiovascular mortality, gingival hyperplasia and hirsutism are known to reduce quality of life. The aim of this prospective study was to evaluate changes in cardiovascular risk profile and cosmetic side eff ects after conversion from CyA to tacrolimus. METHODS 25 stable kidney transplant recipients (9 male, 16 female) were converted from a CyA to a tacrolimus--based regimen. Mean age was 45.7 +/- 13.5 years. Time to switch following transplantation was 4.7+/-1.7 years. Reasons for conversion were multiple: arterial hypertension (9), hypertrichosis (3), gingival hyperplasia (3), hyperlipidemia (14). RESULTS 19/25 patients completed the one year study period. One patient died, two returned to hemodialysis, two were switched back to CyA and one patient was lost to follow-up. There were statistically significant changes (p = < 0.05) in systolic and diastolic pressure and antihypertensive medication could be reduced in 13 patients. The dose of lipid-lowering agents could be reduced in the majority of the recipients and a complete withdrawal was achieved in 7 patients. Hypertrichosis and gingival hyperplasia resolved in all patients. Further, there was a significant improvement (p = <0.05) in urea and serum creatinine levels. Adverse events were consistent with the established safety profile for tacrolimus. CONCLUSIONS Conversion to a tacrolimus-based regimen led to an improvement in the cardiovascular risk profile. Further, cosmetic side eff ects which may lead to non-compliance, resolved after the switch.

[1]  H. Meier‐Kriesche,et al.  Immunosuppressive strategies to improve outcomes of kidney transplantation. , 2007, Seminars in nephrology.

[2]  R. Marcén,et al.  Conversion from cyclosporine microemulsion to tacrolimus in stable kidney transplant patients with hypercholesterolemia is related to an improvement in cardiovascular risk profile: a prospective study. , 2006, Transplantation proceedings.

[3]  H. Chae,et al.  Mechanism of Cyclosporine-induced Overgrowth in Gingiva , 2006, Journal of dental research.

[4]  U. Kunzendorf,et al.  Open prospective multicenter study of conversion to tacrolimus therapy in renal transplant patients experiencing ciclosporin‐related side‐effects , 2005, Transplant international : official journal of the European Society for Organ Transplantation.

[5]  U. Kunzendorf,et al.  Efficacy and safety of tacrolimus compared with cyclosporin A microemulsion in renal transplantation: 2 year follow-up results. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[6]  Artz Marika A.,et al.  Conversion from Cyclosporine to Tacrolimus Improves Quality of Life Indices, Renal Graft Function and Cardiovascular Risk Profile , 2004 .

[7]  G. Borm,et al.  Conversion from Cyclosporine to Tacrolimus Improves Quality‐of‐Life Indices, Renal Graft Function and Cardiovascular Risk Profile , 2004, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[8]  F. Delmonico,et al.  CARDIOVASCULAR RISK PROFILE AFTER CONVERSION FROM CYCLOSPORINE A TO TACROLIMUS IN STABLE RENAL TRANSPLANT RECIPIENTS , 2004, Transplantation.

[9]  M. Schnitzler.  Diabetes Mellitus After Kidney Transplantation in the United States , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[10]  C. Hengstenberg,et al.  Cardiovascular Risk Factors and Estimated Risk for CAD in a Randomized Trial Comparing Calcineurin Inhibitors in Renal Transplantation , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[11]  P. Vescovi,et al.  [Pathogenesis of cyclosporine induced gingival overgrowth]. , 2003, Minerva stomatologica.

[12]  F. Pan,et al.  Tacrolimus and cyclosporine differ in their capacity to overcome ongoing allograft rejection as a result of their differential abilities to inhibit interleukin-10 production1 , 2002, Transplantation.

[13]  I. Castelló.  Hyperlipidemia: a risk factor for chronic allograft dysfunction. , 2002, Kidney international. Supplement.

[14]  Joshua Miller,et al.  A long-term comparison of tacrolimus (FK506) and cyclosporine in kidney transplantation: evidence for improved allograft survival at five years. , 2002, Transplantation.

[15]  R. Hené,et al.  Different effects of tacrolimus and cyclosporine on renal hemodynamics and blood pressure in healthy subjects. , 2002, Transplantation.

[16]  R. Margreiter.  Efficacy and safety of tacrolimus compared with ciclosporin microemulsion in renal transplantation: a randomised multicentre study , 2002, The Lancet.

[17]  R. Gaston.  Maintenance immunosuppression in the renal transplant recipient: an overview. , 2001, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[18]  P. Blankestijn,et al.  Cardiovascular risk factors in renal transplant patients: cyclosporin A versus tacrolimus. , 2001, Journal of the American Society of Nephrology : JASN.

[19]  W. Almawi,et al.  Clinical and mechanistic differences between FK506 (tacrolimus) and cyclosporin A. , 2000, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[20]  S. Matsuda,et al.  Mechanisms of action of cyclosporine. , 2000, Immunopharmacology.

[21]  R. Zietse,et al.  Cholesterol as an independent predictor of outcome after renal transplantation. , 2000, Transplantation.

[22]  J. Barry,et al.  The effect of conversion from cyclosporine to tacrolimus on gingival hyperplasia, hirsutism and cholesterol. , 2000, Transplantation.

[23]  U. Heemann,et al.  Conversion from cyclosporine to tacrolimus in renal transplant recipients with gum hyperplasia. , 1999, Transplantation proceedings.

[24]  S. Busque,et al.  Conversion from Neoral (cyclosporine) to tacrolimus of kidney transplant recipients for gingival hyperplasia or hypertrichosis. , 1998, Transplantation proceedings.

[25]  Z. Varghese,et al.  Elective conversion of patients from cyclosporine to tacrolimus for hypertrichosis. , 1998, Transplantation proceedings.

[26]  W. Padberg,et al.  Improvement of nephrotoxicity, hypertension, and lipid metabolism after conversion of kidney transplant recipients from cyclosporine to tacrolimus. , 1998, Transplantation proceedings.

[27]  P. V. Van Veldhuisen,et al.  Cyclosporine to tacrolimus: effect on hypertension and lipid profiles in renal allografts. , 1998, Transplantation proceedings.

[28]  H. Schlitt,et al.  Pronounced renal vasoconstriction and systemic hypertension in renal transplant patients treated with cyclosporin A versus FK 506 , 1998, Transplant international : official journal of the European Society for Organ Transplantation.

[29]  K. Bendtzen,et al.  Mechanism of Action of Cyclosporin A , 1984, Scandinavian journal of immunology.

[30]  E. Król,et al.  One-year observation of kidney allograft recipients converted from cyclosporine microemulsion to tacrolimus. , 2006, Transplantation proceedings.

[31]  H. Blom,et al.  J Am Soc Nephrol 14: 1880–1888, 2003 Improved Cardiovascular Risk Profile and Renal Function in Renal Transplant Patients after Randomized Conversion from , 2022 .