Systemic and Renal Hemodynamic Differences Between Fk506 and Cyclosporine in Liver Transplant Recipients

Textor, SC; Rh, Wiesner; Wilson, D. R.; Porayko, Michael K.; Romero, J. C.; Burnett, Jr Jc; Gores, Gregory J.; Hay, Eileen; Dickson, E. Rolland; Krom, RA

doi:10.1097/00007890-199306000-00023

Cited by 139 publications

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“…Both drugs produce similar degrees of renal vasoconstriction, reduction of glomerular filtration rate, and enhancement of proximal renal tubular sodium absorption at a time when cyclosporine is associated with a higher incidence of systemic hypertension, findings suggestive of a disproportionate effect of cyclosporine on vascular endothelial function with subsequent systemic vasoconstriction. 3,17,19,20 Higher glucocorticosteroid doses in cyclosporine-treated patients may also contribute to a increased incidence of hypertension. 18 Glucocorticosteroid dose also plays a role in tacrolimus-associated hypertension.…”

Section: Discussionmentioning

confidence: 99%

Late hypertension after liver transplantation: A comparison of cyclosporine and tacrolimus (FK 506)

et al. 1998

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Hypertension frequently develops early after liver transplantation when cyclosporine-based immunosuppression is used. However, initial experience with tacrolimus has suggested that its use leads to a lower early incidence of hypertension. In this study, the blood pressure status of patients treated with cyclosporine (n ‫؍‬ 131) and those treated with tacrolimus (n ‫؍‬ 28) was compared 24 months after liver transplantation. At this time interval, the prevalence of hypertension in the cyclosporine and tacrolimus groups were 82% and 64%, respectively (P F .05). For those patients who were hypertensive by 24 months, onset was delayed in the tacrolimus group compared with the cyclosporine group: 40% versus 71% and 73% versus 93% at 1 and 12 months, respectively (P F .05). Within the cyclosporine group, patients with hypertension were heavier than those with normal blood pressure, 84.7 ؎ 1.8 versus 73.4 ؎ 4.0 kg, respectively (P F .05). Within the tacrolimus group, hypertensive patients had lower glomerular filtration rates and higher renal vascular resistances compared with normotensive patients, 74 ؎ 12 versus 47 ؎ 6 mL/min and 15,711 ؎ 2,445 versus 28,830 ؎ 4,310 dyne/s/cm 5 / m 2 , respectively (P F .05). There were no withingroup differences for age, gender, pretransplant history of hypertension, family history of hypertension, graft function, or daily doses of prednisone, cyclosporine, or tacrolimus. These results indicate that, compared with cyclosporine, the onset of hypertension after liver transplantation is delayed and less prevalent with tacrolimus. Additionally, hypertension is associated with increased body weight in cyclosporine-treated patients and with more severe renal dysfunction in patients receiving tacrolimus. The relationships of these findings to the development of posttransplant hypertension requires further study. Copyright 1998 by the American Association for the Study of Liver DiseasesH ypertension frequently occurs early after liver transplantation when immunosuppression with cyclosporine plus prednisone is used, amounting to a prevalence of 75% to 85% by 24 months. 1-3 Several reports have suggested that the incidence of hypertension in patients treated with tacrolimus (also called FK 506) is lower than that in patients treated with cyclosporine within the first year or two after kidney transplantation, 4-6 up to 3 years after heart transplantation, 7-9 and during the first year after liver transplantation. [10][11][12] We have observed, however, that the prevalence of hypertension in tacrolimus-treated patients increases in the second year after liver transplantation and may approach that observed in patients treated with cyclosporine. 3 We examined the development of hypertension in patients treated with cyclosporine or tacrolimus and followed up for 24 months after liver transplantation. The goals of this study were to assess the prevalence of hypertension in these two patient groups and to compare clinical and laboratory characteristics that might be associated with the development of...

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Section: Discussionmentioning

confidence: 99%

Late hypertension after liver transplantation: A comparison of cyclosporine and tacrolimus (FK 506)

et al. 1998

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“…[8][9][10][11][19][20][21][22][23][24][25][26][27][28][29][30][31][32] These agents cause systemic and afferent arteriolar vasoconstriction by increasing the production of endothelin and thromboxane A 2 and interfering with nitric oxide-mediated vasodilation. [19][20][21][22][23] The afferent arteriolar vasoconstriction results in significant reductions in glomerular filtration rate and renal blood flow. [23][24][25][26] Chronic nephropathy also contributes to the renal insufficiency and is characterized by arteriolar hyalinosis, global glomerulosclerosis, proximal tubule damage, and tubulointerstitial fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21][22][23] The afferent arteriolar vasoconstriction results in significant reductions in glomerular filtration rate and renal blood flow. [23][24][25][26] Chronic nephropathy also contributes to the renal insufficiency and is characterized by arteriolar hyalinosis, global glomerulosclerosis, proximal tubule damage, and tubulointerstitial fibrosis. [25][26][27][28][29][30] This report describes the hemodynamics and pregnancy outcomes after orthotopic liver transplantation at our institution.…”

Section: Discussionmentioning

confidence: 99%

“…Cyclosporine has vasoconstrictive properties and can increase peripheral vascular resistance. 23 Hemodynamic studies have shown that FK506-induced hypertension is not as frequent or as severe as cyclosporine-induced hypertension. 23 FK506 results in a less dramatic release of endothelin and endothelin receptor messenger RNA compared with cyclosporine.…”

Section: Discussionmentioning

confidence: 99%

“…23 Hemodynamic studies have shown that FK506-induced hypertension is not as frequent or as severe as cyclosporine-induced hypertension. 23 FK506 results in a less dramatic release of endothelin and endothelin receptor messenger RNA compared with cyclosporine. 31,32 The decreased systemic vasoconstrictive properties of FK506 may explain the lower rates of early-onset hypertensive complications and fetal growth restriction in patients administered FK506 for immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

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Maternal hemodynamics and pregnancy outcome in women with prior orthotopic liver transplantation

Carr¹,

Larson

Schmucker³

et al. 2000

Liver Transpl

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The aim of this study is to evaluate the hemodynamics and pregnancy outcome of women with prior orthotopic liver transplantation. Hemodynamic measurements by Doppler technique were performed on pregnant subjects with prior orthotopic liver transplantation. Maternal characteristics, renal function, pregnancy complications, delivery indications, delivery mode, and neonatal outcomes were evaluated. Six pregnancies occurred in 5 women after orthotopic liver transplantation at the University of Washington Medical Center (Seattle, WA) between 1991 and 1999. Four of the 6 pregnancies were complicated by chronic hypertension, fetal growth restriction, and preterm delivery. Two pregnancies had worsening hypertension characterized by vasoconstriction in the second trimester despite antihypertensive therapy. These 2 subjects were administered cyclosporine for maintenance immunosuppression and had greater mean arterial pressures preconception and in the first trimester than the other subjects. One of these pregnancies resulted in fetal demise at 25 weeks' gestation. The other subject was delivered at 28 weeks' gestation for nonreassuring fetal status and superimposed preeclampsia. All pregnancies were complicated by renal insufficiency; however, the 2 subjects with poor obstetric outcome had preconception serum creatinine levels greater than 1.5 mg/dL and creatinine clearances less than 40 mL/min. Pregnancies complicated by second-trimester vasoconstriction and moderate renal insufficiency are at risk for preeclamspia, fetal growth restriction, and fetal demise. Good obstetric outcome can occur in women with mild renal insufficiency and well-controlled chronic hypertension. Improved hypertensive control preconception may decrease the risk for preeclampsia and poor obstetric outcome. Copyright 2000 by the American Association for the Study of Liver DiseasesP regnancies in women with prior orthotopic liver transplantation are complicated by fetal growth restriction (9% to 20%), preterm delivery (40% to 86%), cesarean delivery (45% to 71%), and preeclampsia (20% to 71%). 1-5 Significant preeclampsia rates of 27% to 71% have been reported by several investigators who evaluated smaller series of patients. 1,3 However, larger studies 2,5 and registry data 4 report preeclampsia rates in the range of 13.6% to 21%. Most of the women included in these reports were administered cyclosporine, prednisone, and azathioprine as maintenance immunosuppression. Recently, pregnancy outcomes were published for women administered tacrolimus (FK506) for maintenance immunosuppression. These women had lower rates of preeclampsia (0% to 4%), severe chronic hypertension (0% to 11%), and fetal growth restriction (0% to 4%) and similar rates of cesarean delivery (44%) and preterm delivery (48%) as patients administered cyclosporine. 6,7 The increased rate of pregnancy complications is not surprising because both cyclosporine and FK506 are known to cause renal insufficiency and hypertension. [8][9][10][11] Our institution has previously described pregna...

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Cyclosporine vs Tacrolimus Therapy for Posterior and Intermediate Uveitis

Murphy

Greiner²,

Plskova³

et al. 2005

Arch Ophthalmol

150

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Systemic and Renal Hemodynamic Differences Between Fk506 and Cyclosporine in Liver Transplant Recipients

Cited by 139 publications

References 0 publications

Late hypertension after liver transplantation: A comparison of cyclosporine and tacrolimus (FK 506)

Late hypertension after liver transplantation: A comparison of cyclosporine and tacrolimus (FK 506)

Maternal hemodynamics and pregnancy outcome in women with prior orthotopic liver transplantation

Cyclosporine vs Tacrolimus Therapy for Posterior and Intermediate Uveitis

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