Conversion from Cyclosporine to Tacrolimus in Renal Allograft Recipients with Chronic Allograft Nephropathy: Assessment of Efficacy by Repeated Biopsies

Ji Shu-Ming; Chen Jin-Song; Ni Xue-Feng; Xie Ke-Nan; Chen Pei-ling; Wen Ji-Qiu; Cheng Dong-Rui; Li Xue

Volume : V, Issue : I, January - 2015

Conversion from Cyclosporine to Tacrolimus in Renal Allograft Recipients with Chronic Allograft Nephropathy: Assessment of Efficacy by Repeated Biopsies

Ji Shu 45 Ming, Chen Jin 45 Song, Ni Xue 45 Feng, Xie Ke 45 Nan, Chen Pei 45 Ling, Wen Ji 45 Qiu, Cheng Dong 45 Rui, Li Xue

Abstract :

Objectives: This study evaluated the efficacy and safety of tacrolimus (FK506) as secondary intervention in cyclosporine A (CsA) treated renal allograft recipients with chronic allograft nephropathy(CAN). Methods: 176 Patients were either converted to tacrolimus (FK506 group,n=112) or remained on their initial CsA–based immunosuppression (CsA group,n=64) followed over 5–year survey by repeated biopsies. The rate of decline of renal function before and after the FK506 conversion was represented by the regression line (slope) of the reciprocal of serum creatinine versus time. Results: After 5–year of follow–up, serum creatinine was markedly decreased from (160.7±46.3) umol/L to (149.8±49.8) umol/L,P<0.001. Chronic allograft damage index(CADI) significantly decreased from 8.3±2.6 to 3.0±0.7(P<0.001) in FK506 group. Repeated renal biopsy revealed that in FK506 group 56 cases (65.9%) became C4d negative in renal tissue and no case become positive, and 4 case (4.7%) showed steady C4d positive; and in CsA group, no case became C4d negative, 7 cases (13.7%) showed steady C4d positive, and vice versa, there are 16 cases from negative to positive(31.4%). Graft survival rate was significantly increased in the FK506 group than in the CsA group,98.2% vs. 85.9% and 89.3% vs. 56.3% follow–up 5–year, respectively. Conclusion: Conversion from a CsA–based regimen to a tacrolimus–based regimen was an effective alterative for salvage of patients with abnormal graft renal function induced by CAN.