Conversion from cyclosporine-based immunosuppression to tacrolimus/mycophenolate mofetil in patients with refractory and ongoing acute renal allograft rejection

Abstract

Aim of the study: was to examine the influence of conversion from cyclosporine-based therapy to tacrolimus/mycophenolate mofetil (MMF) on renal graft survival in patients with refractory rejection and on the recurrence of rejection in patients converted at the time of the first episode of rejection.

Patients and methods: A total of 64 renal graft recipients were converted to tacrolimus/MMF: 30 patients (Group I) in whom acute allograft rejection was not resolved after anti-rejection therapy; 34 patients (Group II) with first acute rejection, in whom tacrolimus/MMF was an adjunctive therapy to corticosteroid treatment.

Results: In Group I, ten patients failed to recover graft function. Another 10 patients lost their grafts within 2 years after conversion. Two-year graft survival was 30%. Gastro-intestinal complications or leucopenia necessitated immunosuppressants dose reduction or interruption in 50% of the patients. In Group II, recurrence of acute rejection episode occurred in 12% of patients. Ten patients (30%) developed chronic rejection within 2 years after conversion. One and two year kidney graft survival was 97% and 93.6% respectively.

Conclusions: Conversion to tacrolimus/MMF in patients with refractory rejection improved or stabilized renal function, but this effect was short-lasting. Intolerance of immunosuppressive drugs contributed greatly to the treatment inefficacy. Conversion to tacrolimus/MMF during the first acute rejection resulted in low risk of recurrent rejection. Nevertheless, progression to chronic graft nephropathy was observed.