Clinical study of conversion use from CsA to tacrolimus to decrease side effects after kidney transplantation

Aim: To explore the clinical effect of conversion use from cyclosporin A(CsA) based on immunosuppression to the new agent tacrolimus (FK506) after kidney transplantation due to the side effects of CsA. Methods: Forty-seven patients transplanted who were diagnosed as having CsA hepatoxicity,15 patients with hyperlipidemia,5 patients with gingival overgrowth, and 5 patients with hirsuteness in whom FK506 substitute for CsA. The initial dose of FK506 were depended by the patient's weight,liver funtion and time of after operation. The dosage of FK506 was adjusted according to its trough level, and the levels of FK506 were sustained to 8～10 μg/L within 6 months after operation, 6～8 μg/L within one year and 4～6 μg/L later. Liver function, renal function, whole blood FK506 trough concentration serum lipids level, blood sugar and clinical symptoms were observed. Results: The liver function became normal in 45 of 47 patients of this group between 9 and 45 days. Only 2 patients died of liver failure after switched to FK506. Lipids levels decreased significantly in the recipients with hyperlipidemia after conversion to FK506. All of 5 patients experienced significant resolution of their gingival enlargement within the time period studied, however only 3 of them had complete regression. Five recipients with hirsutism benefited from replacing CsA with FK506, and were cured after the switch. Creatinine levels remained stable and no acute rejection was observed in the study. Conclusion: It is concluded that conversion from CsA to FK506 is effective to treat patients with hepatic dysfunction. A switch to FK506 is a safe alternative in cases of hyperlipidemia or hirsuteness after renal transplantation. It is also concluded that conversion for kidney transplantation patients with gingival overgrowth from CsA to FK506 can provide an effective management strategy for this clinical problem. The conversion from CsA based on immunosuppression to FK506 is safe and effective in renal transplant recipients with less side effects.