Clinical heart transplantationPost-operative conversion from cyclosporine to tacrolimus in heart transplantation: a single-center experience☆
Section snippets
Patients and methods
Between 1985 and 2001, 652 heart transplants were performed at Stanford University Medical Center. At the time of transplantation, all patients were treated with a triple immunosuppressive regimen, which included high-dose steroids, azathioprine or mycophenolate mofetil and cyclosporine. Steroids were initially introduced as 1 mg/kg of prednisone in divided doses and this remained stable for the first 2 weeks. In the third week, prednisone was decreased to 0.5 mg/kg and to 0.25 mg/kg in the
Results
Of the 652 patients transplanted during the study period, 109 (16%) were eventually converted from cyclosporine to tacrolimus. Average recipient age for all patients at the time of heart transplant was 45 ± 16 years. Seventy percent of recipients were male and the indication for transplant was ischemic heart disease in 51%. The mean ischemic time was 187 ± 53 minutes. Conversion to tacrolimus was performed at a mean of 28 ± 38 months, with a range of 2 weeks to 13 years post–heart transplant.
Discussion
Over the last decade, tacrolimus has emerged as a safe and effective immunosuppressant drug. Our study showed that there was improvement in blood pressure and decreases in dyslipidemia and incidence of rejection episodes in heart transplant recipients converted from cyclosporine-based to tacrolimus-based immunosuppression.
The benefit of tacrolimus on blood pressure control was observed only in patients who were converted during the first year after heart transplantation. This suggests that,
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Supported by an unrestricted research grant from Fujisawa Healthcare Corp. Dr. Cantin holds a post-doctoral scholarship from the Canadian Institutes of Health Research.