CONVERSION TO TACROLIMUS IN PATIENTS WITH LATE ACUTE AND CHRONIC REJECTION OF TRANSPLANTED KIDNEY

Abstract

Tасrolimus (Tac) has been used for rescuing of renal allografts from refractory rejection that occurred during treatment with conventional cyclosporine A (CsA) mostly in the early posttransplant period. Less is known about effect of Tac in cases of late acute rejection. Aim of the study was to examine the long-term effects of switching from CyA-based therapy to Tac-based therapy versus continuation of CsA in renal transplant patients with acute rejection occurred 3 month after transplantation or later. In this comparative prospective clinical study 176 patients experiencing a late biopsy-proven acute or active chronic rejection were followed-up for up to 6 months. 61 pati- ents were converted from a CуA-based therapy to the Tac one; in 115 patients CsA-based therapy was continued. During the first month after the rejection episode the median serum creatinine concentration had decreased in both groups (from 0.27 (0.18; 0.4) to 0.25 (0.16; 0.41) mmol/l in the CsA group and from 0.25 (0.18; 0.3) to 0.18 (0.14; 0.25) mmol/l in the Tac group. During the follow-up graft function remained stable in the Tac group 0,17 (0,14; 0,3) mmol/l, while in the CsA group a trend to progression of graft failure was observed 0.33 (0.19; 0.8) mmol/l. The 3-year Kaplan-Meier estimates for graft loss were 57,1% (Tac) and 40,9% (CsA), respectively (р < 0.01). Conclusion: early switch from the CsA- to the Tac-based therapy after a late biopsy-confirmed rejection resulted in a significant improvement in the clinical output in renal graft recipients compared to patients for whom the CyA therapy was continued.

Keywords

• kidney transplantation
• acute rejection
• tacrolimus.