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NDT Advance Access published online on July 28, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl397
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions please email: journals.permissions@oxfordjournals.org
Received January 17, 2006
Accepted June 6, 2006

Original Article

Conversion of ciclosporin A to tacrolimus in kidney transplant recipients with chronic allograft nephropathy

Sydney Chi-Wai Tang 1, Kwok Wah Chan 1, Colin Siu-On Tang 1, Man Fai Lam 1, Chung Ying Leung 1, Kai Chung Tse 1, Chun Sang Li 1, Yiu Wing Ho 1, Matthew Kwok-Lung Tong 1, Kar Neng Lai 1, and Tak Mao Chan 1 *, for the Hong Kong Nephrology Study Group

1 Division of Nephrology, Department of Medicine, University of Hong Kong and Queen Mary Hospital, Hong Kong, China

* To whom correspondence should be addressed.
Tak Mao Chan, E-mail: dtmchan{at}hku.hk



  Abstract

Background. Tacrolimus and ciclosporin might have different effects on intra-renal fibrosis and allograft function in chronic allograft nephropathy (CAN). It is difficult to predict the response to calcineurin inhibitor minimization in patients with CAN.

Methods. This prospective randomized study compared ciclosporin A (CsA)-to-tacrolimus conversion (group A, target tacrolimus trough level 6-8 ng/ml) vs CsA minimization (group B, target CsA trough level 80-100 ng/ml) with regard to efficacy and safety in patients with CAN and deteriorating allograft function. The primary efficacy endpoint was improvement in the slope of inverse serum creatinine (1/SCr) vs time plot.

Results. There were 34 evaluable patients (n = 16 in group A; n = 18 in group B), with similar baseline characteristics. Both groups reached target drug levels after a 3-month run-in period. Over the ensuing 12 months, nine (56.3%) subjects in group A and 10 (55.6%) in group B reached the primary end point (P = 0.968). Both groups showed considerable improvement in the slope of 1/SCr vs time plot. There was no significant difference in the slope between groups before and after intervention. Graft survival was 87% in group A and 100% in group B (P = 0.121). Acute rejection was encountered in two group A subjects. There was no significant change or difference in blood glucose, lipids, and blood pressure between groups.

Conclusion. Our results suggest that in patients with CAN and deteriorating allograft function, CsA-to-tacrolimus conversion or CsA minimization achieved comparable efficacies in retarding the decline of graft function. Such contention may be biased by the low patient number. Further studies with a larger cohort are needed for validation.

Keywords: chronic allograft nephropathy; ciclosporin A; minimization; tacrolimus conversion.

Please refer to Appendix for participants in the Study Group.


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[Abstract] [Full Text] [PDF]


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