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Improved Cardiovascular Risk Profile and Renal Function in Renal Transplant Patients after Randomized Conversion from Cyclosporine to Tacrolimus

Marika A. Artz^*, Johannes M.M. Boots, Gerry Ligtenberg, Joke I. Roodnat, Maarten H.L. Christiaans, Pieter F. Vos, Henk J. Blom^||, Fred C.G.J. Sweep^¶, Pierre N.M. Demacker^|| and Luuk B. Hilbrands^*

*Department of Nephrology, University Medical Center of Nijmegen the Netherlands; Department of Nephrology, University Medical Center of Maastricht, the Netherlands; Department of Nephrology, University Medical Center of Utrecht, the Netherlands; Department of Nephrology, University Medical Center of Rotterdam, the Netherlands; ^||Department of Clinical Biochemistry, University Medical Center Nijmegen, the Netherlands; and ^¶Department of Chemical Endocrinology, University Medical Center Nijmegen, the Netherlands

Correspondence to Dr. Marika A. Artz, University Medical Center Nijmegen, Department of Nephrology, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Phone: 31-0-24-3614761; Fax: 31-0-24-3540022;

ABSTRACT. Cyclosporine is considered to contribute to the high cardiovascular morbidity and mortality in patients after renal transplantation. Tacrolimus may be more favorable in this respect, but controlled data are scarce. In this prospective randomized study in 124 stable renal transplant patients, the effects of conversion from cyclosporine to tacrolimus on cardiovascular risk factors and renal function were investigated. Follow-up was 6 mo. Statistical analysis was performed by ANOVA for repeated measurements. The serum creatinine level decreased from 137 ± 30 µmol/L to 131 ± 29 µmol/L (P < 0.01). Three months after conversion from cyclosporine to tacrolimus, mean BP significantly decreased from 104 ± 13 to 99 ± 12 mmHg (P < 0.001). Serum LDL cholesterol decreased from 3.48 ± 0.80 to 3.11 ± 0.74 mmol/L (P < 0.001,) and serum apolipoprotein B decreased from 1018 ± 189 to 935 ± 174 mg/L (P < 0.001). Serum triglycerides decreased from 2.11 ± 1.12 to 1.72 ± 0.94 mmol/L (P < 0.001). In addition, both rate and extent of LDL oxidation were reduced. The fibrinogen level decreased from 3638 ± 857 to 3417 ± 751 mg/L (P < 0.05). Plasma homocysteine concentration did not change. Three months after conversion, plasma fasting glucose level temporarily increased from 5.4 ± 1.3 mmol/L to 5.8 ± 1.9 mmol/L (P < 0.05). Conversion to tacrolimus resulted in a significant reduction of the Framingham risk score. In conclusion, conversion from cyclosporine to tacrolimus in stable renal transplant patients has a beneficial effect on renal function, BP, serum concentration and atherogenic properties of serum lipids, and fibrinogen. E-mail: m.artz@nier.umcn.nl

This article has been cited by other articles:

				A. C. Shirali and M. J. Bia Management of Cardiovascular Disease in Renal Transplant Recipients Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 491 - 504. [Abstract] [Full Text] [PDF]

				R. D. Bloom and M. F. Crutchlow New-Onset Diabetes Mellitus in the Kidney Recipient: Diagnosis and Management Strategies Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(Supplement_2): S38 - S48. [Abstract] [Full Text] [PDF]

				M. A. C. J. Gelens, M. H. L. Christiaans, and J. P. van Hooff Glucose metabolism before and after conversion from cyclosporine microemulsion to tacrolimus in stable renal recipients Nephrol. Dial. Transplant., February 1, 2008; 23(2): 701 - 706. [Abstract] [Full Text] [PDF]

				A. A. Kiykim, C. Ozer, A. Yildiz, N. Tiftik, M. Senli, E. Kelebek, E. Doruk, and E. Akbay Development of transplant renal artery thrombosis and signs of haemolytic-uraemic syndrome following the change from cyclosporin to tacrolimus in a renal transplant patient Nephrol. Dial. Transplant., October 1, 2004; 19(10): 2653 - 2656. [Full Text] [PDF]

				B. Kaplan, J. D. Schold, and H.-U. Meier-Kriesche Long-Term Graft Survival with Neoral and Tacrolimus: A Paired Kidney Analysis J. Am. Soc. Nephrol., November 1, 2003; 14(11): 2980 - 2984. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673