Conversion to cyclosporine provides valuable rescue therapy for living donor adult liver transplant patients intolerant to tacrolimus: A single-center experience at the University of Tokyo

• Published in: Transplantation proceedings Vol. 36; no. 10; pp. 3242 - 3244
• Main Authors: Tamura, S., Sugawara, Y., Kishi, Y., Akamatsu, N., Kaneko, J., Murai, N., Makuuchi, M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2004; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Cyclosporine - pharmacokinetics; Cyclosporine - therapeutic use; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - pharmacokinetics; Immunosuppressive Agents - therapeutic use; Liver Transplantation - immunology; Living Donors; Male; Medical sciences; Middle Aged; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - adverse effects; Tacrolimus - pharmacokinetics; Tissue, organ and graft immunology; Tokyo; Tokyo; Human; Calcineurin inhibitor; Digestive system; Living donor; Liver; Lactone; Transplantation; Homotransplantation; Macrolide; Conversion; Medicine; Drug conversion; Tacrolimus; University; Surgery; Adult; Graft; Ciclosporin; Immunosuppressive agent; Salvage treatment
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2004.11.096

Tacrolimus-based immunosuppression is currently accepted as mainstream therapy in many transplant centers worldwide due to its potent immunosuppressive activity compared to cyclosporine. A tacrolimus-based regimen has been successfully used for our living donor liver transplantation (LDLT) recipients. Adverse effects such as neurotoxicity, nephrotoxicity, and new-onset diabetes mellitus, however, have limited its clinical application. In deceased donor liver transplantation, cyclosporine rescue therapy is valuable for such complications, but few reports have described a strategy for conversion in LDLT. Herein, we present our experience of conversion from tacrolimus to cyclosporine therapy in adult LDLT recipients. Among 203 recipients, 37 patients (18%) required conversion, primarily for neurotoxicity (41%), diabetes mellitus (16%), hematopoietic disorder (16%), and gastrointestinal intolerance (11%). Primary adverse events resolved within 2 months after conversion in 35/37 (94%) of the patients. For LDLT recipients unable to maintain effective immunosuppression with tacrolimus, conversion to cyclosporine is an effective option.