Tacrolimus Versus Ciclosporin for Immunosuppression in Cardiac Transplantation - Short to Mid-Term Renal Effects

摘要

Approximately 100 cardiac transplants are performed yearly in the UK. The choice of maintenance immunosuppression regimes, however, varies due to the dearth of evidence. Tacrolimus and ciclosporin are used most commonly. An added benefit of tacrolimus has been suggested due to reduced rejection rates and side effect profile, particularly nephrotoxicity. The results were reviewed at the Scottish National Advanced Heart Failure Service. A retrospective analysis of data from 50 patients was conducted. All patients had undergone orthotopic heart transplantation between September 2010 and June 2016. In addition to tacrolimus or ciclosporin all patients also received mycophenolate mofetil and corticosteroids. Serum creatinine levels and estimated glomerular filtration rates (eGFR) were compared at 3 monthly intervals during followup post-transplant. Statistical analysis was performed using Student's t-test for continuous variables and Chi-squared test for categorical variables. The drug regimens remained unchanged in all patients through the study period. The eGFR was significantly higher in the ciclosporin group compared to the tacrolimus group at 9 months (p=0.045) and 1 year (p=0.025). There was also a trend towards higher serum creatinine in the tacrolimus group (p=0.125 at 12 months). This study indicates there is a significant impairment of renal function in patients on tacrolimus compared to ciclosporin. Larger studies and longer followup is needed to denote if this impairment is sustained and irreversible.