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Tacrolimus in pediatric heart transplantation: ameliorated side effects in the steroid‐free, statin era
Author(s) -
Simmonds Jacob,
Dewar Catherine,
Dawkins Helen,
Burch Michael,
Fenton Matthew
Publication year - 2009
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2008.00934.x
Subject(s) - medicine , tacrolimus , hyperlipidemia , renal function , diabetes mellitus , transplantation , heart transplantation , concomitant , urology , statin , gastroenterology , surgery , endocrinology
Due to concerns over the side effects of cyclosporine, tacrolimus is widely used in pediatric heart transplantation. However, tacrolimus therapy is also accompanied by potentially serious side effects. This paper examines the side effect profile of tacrolimus in a large group of pediatric heart recipients. Data on renal function, diabetes, hyperlipidemia and hypertension were collected by case‐note review of 100 patients who had received ≥ 12 months treatment with tacrolimus. Forty‐two patients received tacrolimus from the time of transplant ( de novo ), and 58 were initially treated with cyclosporine (switch). Mean estimated glomerular filtration rate improved in the first six months post transplant in the de novo group (66.7–84.6 mL/min/1.73 m 2 , p = 0.002). Conversely, it decreased in those initially treated with cyclosporine (82.1–68.8, p = 0.032), but improved after switch to tacrolimus (77.3–85.6, p = 0.006). Twenty‐one percent exhibited glucose intolerance, and 2% had diabetes. Borderline or elevated fasting cholesterol levels were present in 4.4%. Hypertension was seen in 67% at the point of switch from cyclosporine, which fell to 36% at latest follow‐up (p = 0.001). These results present an encouraging outlook for this cohort of patients. The relatively low levels of complications shown may be due to early weaning of steroids, and concomitant statin therapy.