Early conversion to tacrolimus vs cyclosporine continuation in normally functioning kidney allograft: a single-center study

Document Type : Research article

Authors

1 Department of Clinical Pharmacy, Faculty of pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.

2 Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

3 Urology Research Center, Sina Hospital, Tehran University of Medical sciences, Tehran, Iran.

4 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Abstract

This study evaluated the effectiveness of early pre-emptive conversion from cyclosporine to tacrolimus in kidney transplantation patients with normal graft function and in the absence of adverse effects of the initial cyclosporine. A historical cohort study of 166 patients who received deceased-donor kidney transplant between 2011 to 2017 was conducted. All the patients had been treated with cyclosporine (Sandimmune®) during their immediate post-transplantation period. At the time of hospital discharge, patients were divided into 2 groups: patients with continued cyclosporine (Sandimmune®) treatment (n= 125) and patients whose treatments converted from cyclosporine to tacrolimus (Prograf®) at discharge (n= 41).
The 1-year graft function (p = 0.074), acute rejection (p = 0.566) and graft loss (p = 0.566) were not significantly different between two groups. Patients on tacrolimus had lower levels of cholesterol (p = 0.002) and diastolic blood pressure (p = 0.015). The long-term follow-up showed no significantly difference in graft loss (p = 0.566). Patients received tacrolimus had higher all-causes mortality within the first year posttransplantation (p = 0.002) as well as long-term follow-up (p = 0.001).
The continuation of initial cyclosporine might be a good option when the graft function is acceptable and the adverse effects are absent.

Graphical Abstract

Early conversion to tacrolimus vs cyclosporine continuation in normally functioning kidney allograft: a single-center study

Keywords

References

  1. Usuki S, Uno S, Sugamori H, Tanaka H, Aikawa A and Suki S. Safety and effectiveness of conversion from cyclosporine to once-daily prolonged-release Tacrolimus in stable kidney transplant patients: a multicenter observational study in Japan. Proc. (2018) 50: 3266-74.
  2. Krämer BK, Montagnino G, Del Castillo D, Margreiter R, Sperschneider H, Olbricht CJ, Krüger B, Ortuño J, Köhler H, Kunzendorf U, Stummvoll HK, Tabernero JM, Mühlbacher F, Rivero M and Arias M. Efficacy and safety of Tacrolimus compared with cyclosporine A microemulsion. inrenal transplantation: 2 year follow up results. Nephrol. Dial Transpl. (2005) 20: 968-73.
  3. Radermacher J, Meiners M, Bramlage C, Kliem V, Behrend M, Schlitt HJ, Pichlmayr R, Koch KM and Brunkhorst R. Pronounced renal vasoconstriction and systemic hypertension in renal transplant patients treated with cyclosporine A versus FK 506. Int. (1998) 11: 3-10.
  4. Jevnikar A, Arlen D, Barrett B, Boucher A, Cardella C, Cockfield SM, Rush D, Paraskevas S, Shapiro J, Shoker A, Yilmaz S, Zaltzman JS and Kiberd B. Five-year study of tacrolimus as secondary intervention versus continuation of cyclosporine in renal transplant patients at risk for chronic renal allograft failure. Transplantation (2008) 86: 953-60.
  5. Margreiter R, Pohanka E, Sparacino V, Sperschneider H, Kunzendorf U, Huber W, Lameire N, Andreucci VE, Donati D and Heemann U. Open prospective multicenter study of conversion to tacrolimus therapy in renal transplant patients experiencing cyclosporine-related side-effects. Int. (2005) 18: 816-23.
  6. Kohnle M, Zimmermann U, Lütkes P, Albrecht KH, Philipp T and Heemann U. Conversion from cyclosporine A to tacrolimus after kidney transplantation due to hyperlipidemia. Int. (2000) 13: 345-8.
  7. Kamel M, Kadian M, Srinivas T, Taber D and Posadas Salas MA. Tacrolimus confers lower acute rejection rates and better renal allograft survival compared to cyclosporine. World J. Transplant. (2016) 6: 697–702.
  8. Snowsill TM, Moore J, Mujica Mota RE, Peters JL, Jones-Hughes TL, Huxley NJ, Coelho HF, Haasova M, Cooper C, Lowe JA, Varley-Campbell JL, Crathorne L, Allwood MJ and Anderson R. Immunosuppressive agents in adult kidney transplantation in the National Health Service: a model-based economic evaluation. Dial. Transpl. (2017) 32: 1251-9.
  9. Garces JC. BK Virus–Associated Nephropathy in Kidney Transplant Recipients. J. (2010) 10: 245–9.
  10. Hirsch HH, Vincenti F, Friman S, Tuncer M, Citterio F, Wiecek A, Scheuermann EH, Klinger M, Russ G, Pescovitz MD and Prestele H. Polyomavirus BK replication in de novo kidney transplant patients receiving tacrolimus or cyclosporine: a prospective, randomized, multicenter study. J. Transplant. (2013) 13: 136-45.
  11. Sampaio MS, Cho YW, Shah T, Bunnapradist S and Hutchinson IV. Association of immunosuppressive maintenance regimens with posttransplant lymphoproliferative disorder in kidney transplant recipients. Transplantation (2012) 93: 73-81.
  12. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. J. Transplant. (2009) 9: 1-155.
  13. Marcard T, Ivens K, Grabensee B, Willers R, Helmchen U, Rump LC and Blume C. Early conversion from cyclosporine to tacrolimus increases renal graft function in chronic allograft nephropathy at BAFF stages 1 and 2. Int. (2008) 21: 1153-62.
  14. Shihab FS, Waid TH, Conti DJ, Yang H, Holman MJ, Mulloy LC, Henning AK, Holman J, First MR and CRAF study group. Conversion from cyclosporine to tacrolimus in patients at risk for chronic renal allograft failure: 60-months results of the CRAF study. Transplantation (2008) 85: 1261-9.
  15. Woodle ES, Thistlethwaite JR, Gordon JH, Laskow D, Deierhoi MH, Burdick J, Pirsch JD, Sollinger H, Vincenti F, Burrows L, Schwartz B, Danovitch GM, Wilkinson AH, Shaffer D, Simpson MA, Freeman RB, Rohrer RJ, Mendez R, Aswad S, Munn SR, Wiesner RH, Delmonico FL, Neylan J and Whelchel J. A multicenter trial of FK506 (Tacrolimus) therapy in refractory acute renal allograft rejection: A report of the tacrolimus kidney transplantation rescue Study group. Transplantation (1996) 62: 594-9.
  16. Chamienia A, Biedunkiewicz B, Krol E, Debska-Slizien A and Rutkowski B. One-year observation of kidney allograft recipients converted from cyclosporine microemulsion to tacrolimus. Proc. (2006) 38: 81-5.
  17. Rostaing L, Sánchez-Fructuoso A, Franco A, Glyda M, Kuypers DR and Jaray J. Conversion to tacrolimus once-daily from ciclosporin in stable kidney transplant recipients: a multicenter study. Int. (2012) 25:391-400.
  18. Krejci K, Zadrazil J, Lackova E, Zilinska Z, Roland R and Dedinska I. Clinical experience of conversion from cyclosporine to tacrolimus prolonged-release in stabilized kidney transplant patients. Pap. Med. Fac. Univ. Palacky Olomouc Czech Repub. (2016) 160: 407-11.
  19. Artz MA, Boots JM, Ligtenberg G, Roodnat JI, Christiaans MH, Vos PF, Moons P, Borm G and Hilbrands LB. Conversion from cyclosporine to tacrolimus improves quality of life indices, renal graft function and cardiovascular risk profile. J Transplant. (2004) 4: 937-45.
  20. Plischke M, Riegersperger M, Dunkler D, Heinze G, Kikić Ž, Winkelmayer WC and Plassmann G. Late Conversion of Kidney Transplant Recipients from Cyclosporine to Tacrolimus Improves Graft Function: Results from a Randomized Controlled Trial. PLoS One (2015) 10: e0135674.
  21. Maroun T, Aubert P, Baron C, Bedrossian J, Fornairon S, Lang P, Pruna A and Hiesse C. Rejection therapy with tacrolimus in renal transplantation: preliminary results of a collaborative multicenter study in 45 patients. Proc. (1998) 30: 2811-2.
  22. Morales E, Andrés A, Herrero JC, Dominguez-Gil B, Carreño A, Morales JM, Hernández E, Ortuño T and Praga M. Conversion from cyclosporine to FK 506 as rescue therapy in renal transplantation with poorly steroid-responsive acute rejection. Proc. (1999) 31: 2248-9.
  23. Jordan ML, Shapiro R, Vivas CA, Scantlebury VP, Rhandhawa P, Carrieri G, McCauley J, Demetris AJ, Tzakis A, Fung JJ, Simmons RL, Hakala TR and Starlz TE. FK506 "rescue" for resistant rejection of renal allografts under primary cyclosporine immunosuppression. Transplantation (1994) 57: 860-5.
  24. Silva HT, Yang HC, Meier-Kriesche HU, Croy R, Holman J, Fitzsimmons W and Roy M. Long-Term Follow-Up of a Phase III Clinical Trial Comparing Tacrolimus Extended-Release/MMF, Tacrolimus/MMF, and Cyclosporine/MMF in De Novo Kidney Transplant Recipients. Transplantation (2014) 97: 636–41.
  25. Vincenti F, Friman S, Scheuermann E, Rostaing L, Jenssen T, Campistol JM, Uchida K, Pescovitz MD, Marchetti P, Tuncer M, Citterio F, Wiecek A, Chadban S, El‐Shahawy M, Budde K and Goto N. Results of an International, Randomized Trial Comparing Glucose Metabolism Disorders and Outcome with Cyclosporine Versus Tacrolimus. J. Transplant. (2007) 7: 1506-14.
  26. Ekberg H, Tedesco-Silva H, Demirbas A, Vítko S, Nashan B, Gürkan A, Margreiter R, Hugo C, Grinyó JM, Frei U, Vanrenterghem Y, Daloze P and Halloran PF. Reduced Exposure to Calcineurin Inhibitors in Renal Transplantation. N. Engl. J. Med. (2007) 357: 2562–75.
Iranian Journal of Pharmaceutical Research
Volume 19, Issue 3
Summer 2020
Pages 556-571

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