Conversion from cyclosporine to FK506 in adult liver transplant recipients: A combined North American and European experience

Background. Although cyclosporine (CsA) made clinical liver transplantation possible, side effects and development of rejection have limited its use. In some patients, conversion to tacrolimus has been necessary to abrogate s ide effects and to preserve allograft function. Methods. The results of conversion from CsA to tacrolimus were studied retr ospectively in 94 liver allograft recipients from a North American and a Eu ropean transplant center (Duke University Medical Center, Durham, NC, and H opital Beaujon, Clichy, France). Results. Forty-seven of 94 patients (50%) were converted for steroid-resist ant acute rejection. Conversion was successful in 91% of these patients, wh ereas 9% of patients developed chronic rejection. A further nine patients w ere converted for chronic allograft rejection with positive results in eigh t of nine grafts. Mean serum bilirubin in these nine patients was 8.7 mg(cl l before conversion and 2.1 mg/dl 6 months after conversion (P=0.02). Nine patients were converted due to inability to wean steroid. Of these, six pat ients remains steroid free I year after conversion. Twenty-three patients ( 24%) were converted for nephrotoxicity with a reduction in serum creatinine from 167 +/- 36 mmol/L to 119 +/- 28 mmol/L I year after conversion 0.006) . Eight of 11 patients converted for neurotoxicity improved after conversio n. Conversion to tacrolimus had no effect on seizure frequency or memory lo ss. Conclusions. These results suggest that conversion to tacrolimus from CsA i s an appropriate paradigm for graft rescue and treatment of a variety of si de effects after liver transplant. However, some situations such as memory loss and hypertension may require other strategies.