Tacrolimus rescue therapy for cyclosporine-induced nephrotoxicity

Abstract

Following renal transplantation, the long-term use of cyclosporine can cause nephrotoxicity. This small study of ten patients looks at the effects of tacrolismus rescue therapy over a 6-month period. After conversion to tacrolismus, renal function improved in seven patients, progressive graft dysfunction slowed and almost stabilized in two patients, and, in the remaining patient, deterioration continued and hemodialysis treatment was initiated at the end of the study period. A greater number of patients and a longer follow up are necessary to confirm these initially impressive results.

Chronic renal dysfunction following liver transplantation

“…Regarding calcineurin inhibitor toxicity, some studies have found similar rates of nephrotoxity using either cyclosporine or tacrolimus (3, 18), which seems logical since both drugs use similar pathways. Other studies have demonstrated a possible benefit of tacrolimus over cyclosporine on renal function in kidney transplantation (7, 19, 20), a finding supported by our data that identified CyA as an independent risk factor. However, results comparing the risk of kidney failure through cyclosporine‐ or tacrolimus‐based immunosuppression are often conflicting and of limited value because of the limitations inherent to the study design.…”

“…However, results comparing the risk of kidney failure through cyclosporine‐ or tacrolimus‐based immunosuppression are often conflicting and of limited value because of the limitations inherent to the study design. Studies often target on kidney transplant patients who lack their sympathetic renal innervation, which has been implicated as a possible mechanism for calcineurin inhibitor toxicity (21), or who were switched between two calcineurin inhibitors after chronic renal failure with irreversible structural changes within the kidney had already occurred (19, 20, 22–24).…”

Switching from Cyclosporine to Tacrolimus in Patients with Chronic Transplant Dysfunction or Cyclosporine-Induced Adverse Events

“…These clinical and experimental observations, as well as the idiosyncratic behavior of each patient, may suggest that Tac-based immunosuppression can decrease the frequency of CAN and that Tac use could be also beneficial for patients with documented CAN under CsA. Therefore, switching from CsA to Tac has been proposed as safe and effective in patients with CsA intolerance, nephrotoxicity, or ongoing rejection (15)(16)(17)(18)(19)(20)(21).…”