The Impact on Biochemical Profiles and Allograft Function for Patients Converted from Cyclosporine to Tacrolimus after Clinical Heart Transplantation

Objective. Tacrolimus, a potent calcineurin inhibitor, is a widely used immunosuppressant. This study sought to determine whether conversion from cyclosporine to tacrolimus afforded benefits on biochemical profiles and graft function among Chinese heart transplantation recipients. Methods. Forty-nine patients (44 men and 5 women) among 252 heart transplantations performed from 1995 to 2005 were converted from cyclosporine to tacrolimus due to rejection ( 69%) or to cyclosporine intolerance (31%). The median age of these recipients at transplantation was 46.4 years (range , 5 months to 68 years). Their median body weight was 60 kg( range, 4-84 kg). The allograft median ischemic time was 145 minutes (range, 52-300 minutes) . We compared the biochemical markers, rejection episodes and allograft function. Results. The mean duration from heart transplantation to conversion was 419 days. After conversion , the serum bilirubin and alanine transaminase levels were significantly improved at 1 year. The lipid profiles, including triglycerides, total cholesterol, and low- density lipoprotein were nonsignificantly changed. The rejection episodes significantly decreased from 1.53 to 0.15 per patient per year (P < .001). The left ventricular ejection fraction significantly improved from 54.3 + /- 17.9% to 63.2+ /- 10.9%(P < .01). The right atrial pressure significantly decreased from 9.1 +/- 5.8 mmHg to 6.3 +/- 4.3 mm, Hg (P < . 01). The pulmonary capillary wedge pressure significantly decreased from 15.3 +/- 9.5 mm Hg to 10.8 +/- 5.3 mm Hg (P = .04). Conclusion. In heart transplantation, conversion to tacrolimus owing to rejection or cyclosporine intolerance showed better liver profiles with fewer rejection episodes and improved graft function