Long-Term Efficacy and Safety of Conversion to Tacrolimus in Heart Transplant Recipients with Ongoing or Recurrent Acute Cellular Rejection

Despite the widespread use of potent immunosuppressive drugs,such as cyclosporin A and mycophenolate mofetil, ongoing andrecurrent cellular rejection remain a common problem after hearttransplantation. We aimed to describe the long-term effects ofconversion from cyclosporine A to tacrolimus in patients withongoing and recurrent cellular rejection. This was a single-centreretrospective analysis of 17 heart transplant recipients who wereswitched from cyclosporine A to tacrolimus due to ongoing(5 patients) or recurrent cellular rejection (12 patients). Westudied long-term efficacy and safety of this approach. 167endomyocardial biopsies were performed during a mean followup of 69.1±12.7 months. Thirteen biopsies (7.8 %) in eightpatients (47 %) revealed higher grades of acute cellular rejection(Banff 2). However, they were not hemodynamically significantand did not require intravenous antirejection therapy. The meanrejection score was reduced significantly. Conversion totacrolimus was tolerated in 82 % pts without any significant sideeffects during a long-term follow-up. In conclusion, theconversion to tacrolimus in heart transplant recipients withongoing or recurrent acute cellular rejection was safe andeffective also during a long-term follow-up.