Cor Vasa 2006, 48(12):421-425 | DOI: 10.33678/cor.2006.135

Switching to tacrolimus in heart transplant recipients with recurrent rejection episodes.

Blanka Dufková^*, Ivan Málek, Yevheniya Vymětalová

Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

Aim:
To assess the effect of switching patients undergoing orthotopic heart transplantation (OHTx) with recurrent cellular rejection episodes from cyclosporin A (CyA) to tacrolimus (TAC).

Method:
We followed a group of 17 OHTx patients (5 women, 12 men, age range 53 11 years), switched to TAC in 2001-2005 for repeat findings of higher grades of acute rejection episodes in endomyocardial biopsy (EMB) samples.
We compared the incidence of acute rejection episodes in a total of six EMB samples from each patient, with each three obtained prior to and after switching the patient to TAC. Each grade of the Banff classification was assessed using points (a scale of 1-6 points). The points were subsequently added and a mean for the whole group was calculated. Other end-points included the effect of TAC on blood pressure, serum creatinine and cholesterol levels. Upon conversion, the first dose of TAC was administered at 12 hours after the last CyA administration; the initial dose of 0.1-0.15 mg/kg was divided into two daily doses, with the levels determined after five doses. Goal levels (10-20 ng/mL) were obtained in all patients.

Results:
TAC was tolerated by all patients. The effect on an ongoing acute rejection episode and the decrease in the incidence of higher acute rejection grades after switching the patient to TAC were significant (8.75 ± 1.61 before conversion; 2.56 ± 1.59 after conversion; p < 0.001). The decrease in systolic blood pressure (mmHg) was not significant (133 ± 12.5 prior to conversion; 128 9 after conversion; p = 0.0775), as was not that of diastolic blood pressure (84.4 ± 9.5 before conversion; 83 ± 7,4 after conversion; p = 0.516).
Serum creatinine levels changed only non-significantly after conversion (105 26.1 μmol/L before conversion, and 109 ± 26.07 μmol/L after conversion; p = 0.158). By contrast, cholesterol levels declined significantly after conversion (5.2 ± 1.06 mmol/L before conversion; 4.7 ± 0.84 mmol/L after conversion; p = 0.0026).

Conclusion:
Tacrolimus has a beneficial effect not only on recurrent acute rejection episodes, it also decreases the incidence of future rejection episodes. Switching the patient from cyclosporin A to tacrolimus resulted in a decrease in cholesterol levels. Switching to tacrolimus is a suitable therapeutic option in patients experiencing recurrent acute rejection episodes.

Keywords: Heart transplantation; Acute cellular rejection; Tacrolimus; Cyclosporin A

Published: December 1, 2006  Show citation