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OUR EARLY EXPERIENCE OF TACROLIMUS CONVERSION IN THE KIDNEY TRANSPLANTS.
Mahmut Can Yagmurdur, M.D. , Sinasi Sevmis M.D. , Remzi Emiroglu M.D. , Gokhan Moray M.D. , Hamdi Karakayali M.D. and Nevzat Bilgin M.D. . Ankara Turkey, Baskent University, 06490, General Surgery and Transplantation .
Tacrolimus has been known as an effective immunosuppressive drug since 1987, in our clinic we have begun to use this agent from November 1999.
Materials and methods: Our transplantation team performed 1,359 kidney transplantations since 1975. Until November 1999, all these recipients received a standard low-dose triple-drug immunosuppressive regimen of prednisolone, azathioprine, and cyclosporine A. Since November 1999, cyclosporine A was converted to tacrolimus in 95 kidney recipients. In this study, our early results were analysed.
Results: The mean follow up period after alteration of immunosuppressive protocol was 12 (1-24) months. The mean time interval between transplantation and tacrolimus conversion was 34±11,4 months (1-158 months. Chronic allograft nephropathy in 16(17%) patients, nephrotoxicity related to cyclosporine A in 22(23%) patients and steroid resistant acute rejection in 57(58%) were the indications of tacrolimus conversion. There were 1 acute rejection episode in 32, 2 in 18 and 3 in 11 patients before starting the tacrolimus. After the drug conversion, 1 acute rejection in 17 and 2 acute rejection in 4 patients were observed. Graft loss was seen in 15(15%) patients after the drug conversion. Tacrolimus was withdrawn due to diabetes mellitus in 7, epilepsy in 4, severe nocardia sepsis, lymphoma and Kaposi sarcoma each in one patient. Decreases of serum creatinin levels and also, increases in blood glucose levels showed statistically significant association with tacrolimus doses (p=0.0004, p=0.04). Conclusion: Tacrolimus conversion can be succesful in cases of rejection and nephrotoxicity, but dose dependent blood glucose elevations must be followed closely in these patients.