Conversion from Cyclosporin to Tacrolimus in Paediatric Liver Transplant Recipients

Abstract

Substitution of cyclosporin with tacrolimus should be considered for paediatric liver transplant recipients with cyclosporin-associated complications such as hypertension, gum hyperplasia, hirsutism, gynaecomastia and growth retardation, as well as recurrent or refractory acute rejection, chronic duct injury or chronic rejection. Continued experience with well tolerated drug administration and careful monitoring during drug substitution has limited drug toxicity associated with tacrolimus to a level comparable to or less than that associated with cyclosporin. Successful outcome with long term graft salvage has been reported in up to 80% of patients converted to tacrolimus because of acute rejection and 50% of patients converted because of chronic rejection. Nearly all children converted because of cyclosporin-related complications have a successful outcome. Additional benefits of conversion to tacrolimus include improvement in growth and resolution of hypertension, hirsutism and cushingoid facies. Complete corticosteroid withdrawal is possible in up to 78% of children post-conversion. Long term outcome in these patients may be optimised by conversion to tacrolimus at an early stage of acute or chronic transplant rejection in order to minimise the cumulative amount of immunosuppression. Avoidance of cyclosporin-related toxicity and minimisation of corticosteroid therapy may further improve patient compliance to drug therapy.

Prenatal Exposition to Different Immunosuppressive Protocols Results in Vacuolar Degeneration of Hepatocytes

“…They noted altered liver architecture manifested by dilation of hepatic sinusoids, dearranged hepatocyte with cytoplasmic swelling and presence of glycogen globules [44]. According to available data, conversion from CsA to TAC is used in case of graft-rejection risk [45][46][47][48].…”

Hormonal (Im)Balance and Reproductive System’s Disorders in Transplant Recipients—A Review

“…The case report concerned two men only and thus it was probably not a representative trial, however the conclusion to be drawn is that cyclosporin A seems to be the immunosuppressive drug that affects hormonal balance to a higher degree, when compared with tacrolimus [35]. Nevertheless, it should be mentioned that the mechanism of cyclosporin A-related gynecomastia is not clearly comprehended, however, it is known that reduction of a dose of cyclosporin A or conversion from cyclosporin A to Tc or discontinuation of cyclosporin A treatment, restores hormonal status to that of before-the-surgery and concomitantly reduces gynecomastia [35,36]. Although gynecomastia is usually related with hyperprolactinemia, it is already known that cyclosporin A strongly inhibits the process of 2-hydroxylation and 17-oxidation of E2, therefore increasing the synthesis of E2 [35].…”

Allogenic umbilical cord blood therapy combined with erythropoietin for patients with severe traumatic brain injury: Three case reports

“…Ten days after the therapy, liver enzymes increased. Because this was thought to be caused by cyclosporine, the immunosuppressant was changed to tacrolimus (Mazariegos et al, 2001). With hepatotonic agents and the change in the immunosuppressant, the liver enzymes normalized in 5 days (Table 1-B).…”