Treatment of tacrolimus-related adverse effects by conversion to cyclosporine in liver transplant recipients

When tacrolimus side effects persist despite dose reduction, conversion to cyclosporine-based immunosuppression (CyA) is necessary. We characterized t acrolimus side effects that warranted discontinuation of the drug, and outc omes after conversion. Of 388 liver recipients who received tacrolimus as p rimary immunosuppression, 70 required conversion to CyA. We recorded indica tion for conversion, whether conversion was early or late after transplanta tion, tacrolimus dose and trough blood level at conversion, and incidence o f rejection after conversion. Conversion was early in 29 patients (41.4 %) and late in 41 (58.6 %). Indications for early conversion were neurotoxicit y (20), (insulin-dependent) diabetes mellitus (IDDM) (5), nephrotoxicity (3 ), gastrointestinal (GI) toxicity (6), and cardiomyopathy (1), and for late conversion were neurotoxicity (15), IDDM (12), nephrotoxicity (3), GI toxi city (5), hepatotoxicity (6), post-transplant Imphoproliferate disease (PTL D) (2), cardiomyopathy (1), hemolytic anemia (1), and pruritis (1). All ear ly-conversion patients showed improvement/resolution of symptoms. Among lat e-conversion patients, 37 (90.2 %) had improvement/resolution; in 4 (9.8 %) , adverse effects persisted. The overall rejection rate was 30 %. Sixty-two patients (88.6 %) are alive with functioning grafts 686 +/- 362 days (rang e, 154-1433 days) after conversion. When tacrolimus side effects are unresp onsive to dose reduction, conversion to CyA can be accomplished safely, wit h no increased risk of rejection and excellent long-term outcome.