CONVERSION TO TACROLIMUS IN PATIENTS WITH LATE ACUTE AND CHRONIC REJECTION OF TRANSPLANTED KIDNEY

• Main Authors: E. S. Stolyarevich, L. Y. Artjukhina, I. G. Kim, L. G. Kurenkova, N. D. Fedorova, A. V. Frolov, N. F. Frolova, N. A. Tomilina
• Format: Article
• Language: Russian
• Published: Federal Research Center of Transplantology and Artificial Organs named after V.I.Shumakov 2011-06-01
• Series: Vestnik Transplantologii i Iskusstvennyh Organov
• Subjects: kidney transplantation; acute rejection; tacrolimus.
• Online Access: https://journal.transpl.ru/vtio/article/view/371

Tасrolimus (Tac) has been used for rescuing of renal allografts from refractory rejection that occurred during treatment with conventional cyclosporine A (CsA) mostly in the early posttransplant period. Less is known about effect of Tac in cases of late acute rejection. Aim of the study was to examine the long-term effects of switching from CyA-based therapy to Tac-based therapy versus continuation of CsA in renal transplant patients with acute rejection occurred 3 month after transplantation or later. In this comparative prospective clinical study 176 patients experiencing a late biopsy-proven acute or active chronic rejection were followed-up for up to 6 months. 61 pati- ents were converted from a CуA-based therapy to the Tac one; in 115 patients CsA-based therapy was continued. During the first month after the rejection episode the median serum creatinine concentration had decreased in both groups (from 0.27 (0.18; 0.4) to 0.25 (0.16; 0.41) mmol/l in the CsA group and from 0.25 (0.18; 0.3) to 0.18 (0.14; 0.25) mmol/l in the Tac group. During the follow-up graft function remained stable in the Tac group 0,17 (0,14; 0,3) mmol/l, while in the CsA group a trend to progression of graft failure was observed 0.33 (0.19; 0.8) mmol/l. The 3-year Kaplan-Meier estimates for graft loss were 57,1% (Tac) and 40,9% (CsA), respectively (р < 0.01). Conclusion: early switch from the CsA- to the Tac-based therapy after a late biopsy-confirmed rejection resulted in a significant improvement in the clinical output in renal graft recipients compared to patients for whom the CyA therapy was continued.