Subclinical Inflammation in Renal Transplant Recipients: Impact of Cyclosporine Microemulsion Versus Tacrolimus

• Published in: Transplantation proceedings Vol. 39; no. 7; pp. 2170 - 2172
• Main Authors: Lauzurica, R, Pastor, M.C, Bayes, B, Malumbres, S, Homs, M, Llopis, M.A, Bonet, J, Romero, R
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2007; Elsevier Science
• Subjects: Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Cyclosporine - adverse effects; Cyclosporine - therapeutic use; Emulsions; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Inflammation - immunology; Kidney Transplantation - immunology; Medical sciences; Multivariate Analysis; Pharmacology. Drug treatments; Prospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - adverse effects; Tacrolimus - therapeutic use; Tissue, organ and graft immunology; Calcineurin inhibitor; Lactone; Asymptomatic; Inflammation; Transplantation; Homotransplantation; Macrolide; Kidney; Immunomodulator; Medicine; Treatment; Urinary system; Tacrolimus; Surgery; Graft; Ciclosporin; Protein synthesis inhibitor; Immunosuppressive agent; Antibacterial agent; Microemulsion; Comparative study
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2007.06.023

Abstract Background Renal insufficiency and renal transplant (RT) provoke a microinflammatory state that leads to increased atherosclerosis. It is not fully known whether calcineurin inhibitors (CNIs) play a role in the inflammation observed in these patients or whether any differences exist between CNIs. Objectives The study aimed to establish differences in the inflammatory state of two groups treated with cyclosporine microemulsion (CyA) or tacrolimus (TC). Patients and methods This prospective study included 81 RT patients divided into two groups according to the CNI: CyA group, n = 35 versus TC group, n = 46. The markers of inflammation (MIF) were determined preRT and at 3 and 12 months’ postRT: C-reactive protein (CRP), serum amyloid protein A (SAA), interleukin-6 (IL-6), soluble interleukin-2 receptor (sIL-2R), tumor necrosis factor-alpha (TNF-α), and pregnancy-associated plasma protein A (PAPP-A). Samples were collected in stable patients in the absence of rejection, active infection, or inflammatory processes. Results No significant differences existed between the markers of inflammation in the two treatment groups prior to transplantation. At 3 months’ posttransplant, patients treated with CyA showed significantly higher levels of IL-6 ( P = .05), SAA ( P = .03), and sIL-2R ( P = .008) compared with patients treated with TC. These differences were maintained for IL-6 ( P = .03) and sIL-2R ( P = .027) at 12 months’ posttransplant. A multivariate analysis at 3 months showed that only age [OR 10.1; CI (95% 2.6–38.4); P = .001], SAA [OR 4.8; IC (95% 1.4–16.5); P = .015], and sIL-2R [OR 4.9; IC (95% 1.5–16.2); P = .009] were independent predictors of the CNI used. At 12 months, age [OR 3.7; IC (95% 0.9–14.2] and sIL-2R [OR 6.04; IC (95% 1.5–23); P = .006] continued to be independent predictors. Conclusions Patients treated with CyA displayed significantly higher levels of inflammatory markers (IL-6, SAA, sIL-2R) at 3 and 12 months’ posttransplantation, independent of age, gender, time on dialysis, diabetes mellitus (preRT and de novo postRT), and renal function measured by serum creatinine.