2010 - TTS International Congress

This page contains exclusive content for the member of the following sections: TTS. Log in to view.

Clinical Immunosuppression Kidney late

19.11 - Switching from Cyclosporine to Tacrolimus : benefical effect in patients with late ac ute rejection

Presenter: Ekaterina, Stolyarevich, Moscow, Russian Federation
Authors: Stolyarevich E.



E. Stolyarevich
, Resecarh Institute of Transplantology and Artificial Organs, Moscow/RUSSIAN FEDERATION

Body: Introduction: Tacrolimus (Tac) has been used for rescuing of renal allografts from refractory rejection that occurred during treatment with conventional cyclosporine A (CyA) mostly in the earlyposttransplant period. Less is known about effect of Tac in cases of late acute rejection. Here we report our experience of Tac rescue therapy in patients with late acute rejections which occurred 3month after transplantation or later.
Aim of the study was to examine the long-term effects of switching from CyA-based therapy to Tac-based therapy versus continuation of CyA in renal transplant patients with late acute rejection.
Methods: In this comparative prospective clinical study 128 patients (median age 33 years; range 16 to 67 years; 74 males, 54 females) experiencing a late biopsy-proven acute rejection werefollowed-up for up to 1 year. The median rejection time was 35.1 months (range 3 to 101 months) after transplantation. 44 patients were converted from a CуA- based therapy to the Tac one; in 84 patients CsA-based therapy was continued. Acute rejection episodes were treated with intravenous methylprednisolone (ME) pulses (0.5 g on three consecutive days). Switch to Tac was undertakenat an initial dose of 0.15 mg/kg/d, which was subsequently adjusted to maintain Tac blood trough levels between 5 and 10 ng/ml. Cyclosporine whole blood level was maintained in the range of 150 to200 ng/mL. Rejection diagnosis was based on the strict Banff criteria. The incidence of graft loss, treatment failure, and death were analysed using Kaplan-Meier methods. Comparisons between the twogroups were made using Mann-Whitney and Wilcoxon tests. Baseline clinical and pathological characteristics were comparable for both groups. The 1-year Kaplan-Meier estimates for graft loss were 84.2%(Tac) and 63.2% (CyA-ME), respectively (P=0.01). During the first month after the rejection episode the median serum creatinine concentration had decreased in both groups (from 0.29 to 0.26 mmol/l inthe CsA group and from 0.25 to 0.19 mmol/lin the Tac group (see Table) In a year after graft function remained stable in the Tac group (0,17 (0,14;0,27) mmol/l), while in the CsA group a trend toprogression of graft failure was observed (0.3(0.2;0.8) mmol/l).

Disclosure: All authors have declared no conflicts of interest.

Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.



Staff Directory


The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6