Details
| Original language | English |
|---|---|
| Pages (from-to) | 1153-1162 |
| Number of pages | 10 |
| Journal | Transplant International |
| Volume | 21 |
| Issue number | 12 |
| Early online date | 6 Nov 2008 |
| Publication status | Published - Dec 2008 |
| Externally published | Yes |
Abstract
Switching from cyclosporine to tacrolimus without steroid pulse was suggested as a therapeutic option in chronic allograft nephropathy (CAN). Thirty-one renal transplant recipients with CAN were prospectively converted from cyclosporine to tacrolimus (group A), in parallel 31 matched cyclosporin A (CsA) patients (group B) without CAN were followed up for 30 months. In six matching patients of groups A and B inulin and para-aminohippurate (PAH)-clearances and mycophenolate were measured over a span of 3 months. Transplant biopsies of group A were scored according to BANFF. While group A presented with transplant dysfunction compared with group B before switching (2.7 ± 0.16 mg/dl vs. 1.7 ± 0.09 mg/dl; P < 0.001), transplant function was equal 30 months later: it ameliorated in group A (2.0 ± 0.18 mg/dl vs. 2.7 ± 0.16 mg/dl; P < 0.001) and decreased in group B (1.9 ± 0.13 mg/dl vs. 1.7 ± 0.09 mg/dl, P < 0.05). Especially, patients with biopsy scores I and II according to BANFF benefited from tacrolimus. Within 3 months, mycophenolate acid (MPA) levels increased under tacrolimus (P < 0.05) whereas inulin and PAH-clearances remained unchanged. At switching, antihypertensive treatment was more intense in group B, but this difference evened out. Adverse side effects were more frequent under tacrolimus. Patients with mild to moderate CAN significantly benefited from switching to tacrolimus. Increased MPA-levels under tacrolimus might have contributed to this effect.
Keywords
- Chronic allograft nephropathy, Cyclosporin A, Kidney transplant, Mycophenolate mofetil, Nephrotoxicity, Tacrolimus
ASJC Scopus subject areas
- Medicine(all)
- Transplantation
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In: Transplant International, Vol. 21, No. 12, 12.2008, p. 1153-1162.
Research output: Contribution to journal › Article › Research › peer review
}
TY - JOUR
T1 - Early conversion from cyclosporine to tacrolimus increases renal graft function in chronic allograft nephropathy at BANFF stages I and II
AU - Marcard, Thorsten
AU - Ivens, Katrin
AU - Grabensee, Bernd
AU - Willers, Reinhart
AU - Helmchen, Udo
AU - Rump, Lars Christian
AU - Blume, Cornelia
PY - 2008/12
Y1 - 2008/12
N2 - Switching from cyclosporine to tacrolimus without steroid pulse was suggested as a therapeutic option in chronic allograft nephropathy (CAN). Thirty-one renal transplant recipients with CAN were prospectively converted from cyclosporine to tacrolimus (group A), in parallel 31 matched cyclosporin A (CsA) patients (group B) without CAN were followed up for 30 months. In six matching patients of groups A and B inulin and para-aminohippurate (PAH)-clearances and mycophenolate were measured over a span of 3 months. Transplant biopsies of group A were scored according to BANFF. While group A presented with transplant dysfunction compared with group B before switching (2.7 ± 0.16 mg/dl vs. 1.7 ± 0.09 mg/dl; P < 0.001), transplant function was equal 30 months later: it ameliorated in group A (2.0 ± 0.18 mg/dl vs. 2.7 ± 0.16 mg/dl; P < 0.001) and decreased in group B (1.9 ± 0.13 mg/dl vs. 1.7 ± 0.09 mg/dl, P < 0.05). Especially, patients with biopsy scores I and II according to BANFF benefited from tacrolimus. Within 3 months, mycophenolate acid (MPA) levels increased under tacrolimus (P < 0.05) whereas inulin and PAH-clearances remained unchanged. At switching, antihypertensive treatment was more intense in group B, but this difference evened out. Adverse side effects were more frequent under tacrolimus. Patients with mild to moderate CAN significantly benefited from switching to tacrolimus. Increased MPA-levels under tacrolimus might have contributed to this effect.
AB - Switching from cyclosporine to tacrolimus without steroid pulse was suggested as a therapeutic option in chronic allograft nephropathy (CAN). Thirty-one renal transplant recipients with CAN were prospectively converted from cyclosporine to tacrolimus (group A), in parallel 31 matched cyclosporin A (CsA) patients (group B) without CAN were followed up for 30 months. In six matching patients of groups A and B inulin and para-aminohippurate (PAH)-clearances and mycophenolate were measured over a span of 3 months. Transplant biopsies of group A were scored according to BANFF. While group A presented with transplant dysfunction compared with group B before switching (2.7 ± 0.16 mg/dl vs. 1.7 ± 0.09 mg/dl; P < 0.001), transplant function was equal 30 months later: it ameliorated in group A (2.0 ± 0.18 mg/dl vs. 2.7 ± 0.16 mg/dl; P < 0.001) and decreased in group B (1.9 ± 0.13 mg/dl vs. 1.7 ± 0.09 mg/dl, P < 0.05). Especially, patients with biopsy scores I and II according to BANFF benefited from tacrolimus. Within 3 months, mycophenolate acid (MPA) levels increased under tacrolimus (P < 0.05) whereas inulin and PAH-clearances remained unchanged. At switching, antihypertensive treatment was more intense in group B, but this difference evened out. Adverse side effects were more frequent under tacrolimus. Patients with mild to moderate CAN significantly benefited from switching to tacrolimus. Increased MPA-levels under tacrolimus might have contributed to this effect.
KW - Chronic allograft nephropathy
KW - Cyclosporin A
KW - Kidney transplant
KW - Mycophenolate mofetil
KW - Nephrotoxicity
KW - Tacrolimus
UR - http://www.scopus.com/inward/record.url?scp=55649119823&partnerID=8YFLogxK
U2 - 10.1111/j.1432-2277.2008.00731.x
DO - 10.1111/j.1432-2277.2008.00731.x
M3 - Article
C2 - 18684111
AN - SCOPUS:55649119823
VL - 21
SP - 1153
EP - 1162
JO - Transplant International
JF - Transplant International
SN - 0934-0874
IS - 12
ER -