Tacrolimus as a rescue immunosuppressant after heart transplantation

Objective: The purpose of this retrospective study is to review our experie nce with tacrolimus as a rescue immunosuppressant for heart transplant reci pients with refractory rejection or cyclosporine intolerance. Methods: From June 1995 to November 1998, 15 cardiac transplant recipients were converte d from our standard cyclosporine-based immunosuppressive regimen to a tacro limus-based treatment. Each patient had been treated with cyclosporine, aza thioprine and steroids. Six were switched to tacrolimus for persistent reje ction, four for recurrent acute rejection and five for severe debilitating side-effects attributed to cyclosporine. All ten patients converted to tacr olimus because of rejection had been treated with high-dose methylprednisol one intravenously and four had also received anti-lymphocyte globulin (ALG; one patient) or anti-thymocyte globulin (ATG; three patients) preparations . Results: The time between transplantation and conversion to tacrolimus ra nged from 44 to 1866 (median, 380) days. The range of follow-up after conve rsion was 84-1379 (median, 806) days. Eleven patients are alive with a foll ow-up period of 764 +/- 435 (median, 820) days. Four patients died between 90 and 930 (median, 464) days after conversion. The average number of episo des of acute rejection/recipient decreased from 2.1 +/- 1.6 on the cyclospo rine regimen to 0.2 +/- 0.4 on the tacrolimus regimen (P < 0.001). When the incidence of acute rejection was normalized for follow-up times (episodes/ 100 patient-days), the results were 1.1 +/- 1.4 and 0.07 +/- 0.2, respectiv ely (P < 0.01). The persistent/recurrent rejection resolved in all ten pati ents who were converted to tacrolimus. None of the five cyclosporine intole rant patients converted to tacrolimus experienced rejection after the chang eover. Conclusions: In our experience, conversion from a cyclosporine-based to a tacrolimus-based maintenance immunosuppression has been shown to be a n effective and safe approach to the management of patients with persistent or recurrent cardiac allograft rejection or those with cyclosporine intole rance. (C) 2001 Elsevier Science B.V. All rights reserved.