Efficacy and safety of tacrolimus compared with cyclosporin A microemulsion in renal transplantation: 2 year follow-up results

Krämer, Bernhard K.; Montagnino, Giuseppe; Castillo, Domingo del; Margreiter, Raimund; Sperschneider, H; Olbricht, Christoph J.; Krüger, Bernd; Ortuño, J; Köhler, Hans; Kunzendorf, Ulrich; Stummvoll, Hans-Krister; Tabernero, Josep; Mühlbacher, Ferdinand; Rivero, M.; Arias, Manuel

doi:10.1093/ndt/gfh739

Cited by 123 publications

(89 citation statements)

References 18 publications

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“…The study confirmed that patients treated with tacrolimus have better cardiovascular risk profiles compared with cyclosporine-treated patients (30,31,32). Cyclosporine patients in our study had higher cholesterols and systolic BP, as expected.…”

Section: Discussionsupporting

confidence: 89%

Cardiovascular Outcomes in the Outpatient Kidney Transplant Clinic

Kiberd¹,

Panek²

2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: Cardiovascular disease is an important cause of morbidity and death in kidney transplant recipients. This study examines the Framingham risk score's ability to predict cardiac and stroke events. Because cyclosporine and tacrolimus have different cardiovascular risk profiles, these agents were also examined.Design, setting, participants, & measurements: A prospective cohort evaluation of 540 patients were followed for a median of 4.7 yr in an outpatient kidney transplant clinic. Baseline Framingham risk scores were calculated and all cardiovascular outcomes were collected.Results: Rates per 100 patient-years were 1.79 for cardiac and 0.78 for stroke events. The ratio of observed-to-predicted cardiac events was 1.64-fold higher [95% confidence interval (CI) 1.19 to 2.94] for the cohort, 2.74-fold higher (95% CI 1.70 to 4.24) in patients age 45 to 60 with prior cardiac disease or diabetes mellitus, but not higher in other age subgroups. Stroke was not increased above predicted. Risk scores for cardiac (c ‫؍‬ 0.65, P ‫؍‬ 0.003) and stroke (c ‫؍‬ 0.71, P ‫؍‬ 0.004) events were modest predictors. 10-yr event scores for cardiac (9.3 versus 13.5%, P < 0.001) and stroke (7.1 versus 10.0%, P ‫؍‬ 0.002) were lower for tacrolimus compared with cyclosporine-treated patients. However observed cardiac events were higher in tacrolimus recipients (2.50, 95% CI 1.09 to 5.90) in an adjusted Cox model. Conclusions: Although risk scores are only modest predictors, patients with the highest event rates are easily identified. Treating high-risk patients with cardioprotective medications should remain a priority.

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Section: Discussionsupporting

confidence: 89%

Cardiovascular Outcomes in the Outpatient Kidney Transplant Clinic

Kiberd¹,

Panek²

2008

Clinical Journal of the American Society of Nephrology

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“…Newer maintenance immunosuppressive regimes, featuring tacrolimus and mycophenolate mofetil, have reduced the acute rejection rate; however, their effect on long-term graft outcome is not without debate. [2][3][4][5][6][7] One-year graft survival rates in our cohort of patients have improved from 82% to 86% in the period 1986-2001. [8] Irish Renal Transplant Registry data indicate that our acute rejection rate has improved from 30% in the 1990s to less than 10% currently.…”

Section: Introductionmentioning

confidence: 99%

MDRD-Estimated GFR at One Year Post-Renal Transplant Is a Predictor of Long-Term Graft Function

et al. 2008

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“…Graft loss, patient death and biopsy-proven acute rejection occurred signifi cantly more frequently in patients treated with cyclosporin than in the tacrolimus arm. Graft function at 2 years post-transplantation was signifi cantly better and cholesterol and triglycerides concentrations were lower in the tacrolimus arm compared to the cyclosporine arm 21 . In the European Switch to Tacrolimus Study 296 adult kidney transplant patients with cyclosporine related side eff ects were converted to tacrolimus.…”

Section: Discussionmentioning

confidence: 96%

Improvement of Cardiovascular Risk Factors and Cosmetic Side Effects in Kidney Transplant Recipients After Conversion to Tacrolimus

Zadrazil¹,

Horák²,

Zahálková³

et al. 2009

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims:Tacrolimus and Cyclosporine A (CyA) are cornerstones in immunosuppressive therapy. Cyclosporine side eff ects include hypertension and hypercholesterolemia both of which may increase the risk of cardiovascular mortality, gingival hyperplasia and hirsutism are known to reduce quality of life. The aim of this prospective study was to evaluate changes in cardiovascular risk profi le and cosmetic side eff ects after conversion from CyA to tacrolimus.Methods: 25 stable kidney transplant recipients (9 male, 16 female) were converted from a CyA to a tacrolimusbased regimen. Mean age was 45.7 ± 13.5 years. Time to switch following transplantation was 4.7±1.7 years. Reasons for conversion were multiple: arterial hypertension (9), hypertrichosis (3), gingival hyperplasia (3), hyperlipidemia (14).Results: 19/25 patients completed the one year study period. One patient died, two returned to hemodialysis, two were switched back to CyA and one patient was lost to follow-up. There were statistically signifi cant changes (p = < 0.05) in systolic and diastolic pressure and antihypertensive medication could be reduced in 13 patients. The dose of lipid-lowering agents could be reduced in the majority of the recipients and a complete withdrawal was achieved in 7 patients. Hypertrichosis and gingival hyperplasia resolved in all patients. Further, there was a signifi cant improvement (p = <0.05) in urea and serum creatinine levels. Adverse events were consistent with the established safety profi le for tacrolimus.Conclusions: Conversion to a tacrolimus-based regimen led to an improvement in the cardiovascular risk profi le. Further, cosmetic side eff ects which may lead to non-compliance, resolved after the switch.

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Efficacy and safety of tacrolimus compared with cyclosporin A microemulsion in renal transplantation: 2 year follow-up results

Cited by 123 publications

References 18 publications

Cardiovascular Outcomes in the Outpatient Kidney Transplant Clinic

Cardiovascular Outcomes in the Outpatient Kidney Transplant Clinic

MDRD-Estimated GFR at One Year Post-Renal Transplant Is a Predictor of Long-Term Graft Function

Improvement of Cardiovascular Risk Factors and Cosmetic Side Effects in Kidney Transplant Recipients After Conversion to Tacrolimus

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