Do blood pressure and arterial wall properties change after conversion from cyclosporine to tacrolimus?

Area of Science:

• Nephrology
• Cardiology
• Immunology

Background:

• Cardiovascular disease is a primary cause of mortality in renal transplant recipients.
• Arterial wall properties serve as indicators of arteriosclerosis.
• Prior studies suggest tacrolimus offers a better cardiovascular risk profile than cyclosporine, with improvements in renal function, blood pressure, and lipids.

Purpose of the Study:

• To investigate the impact of switching from cyclosporine to tacrolimus on arterial wall properties in stable renal transplant recipients.
• To evaluate changes in cardiovascular risk factors following immunosuppressant conversion.

Main Methods:

• Thirty-four stable renal transplant recipients were switched from cyclosporine microemulsion to tacrolimus.
• Assessments included arterial wall imaging (carotid and brachial arteries), pulse wave velocity (PWV), laboratory tests, 24-hour ambulatory blood pressure monitoring (ABPM), renal function (Cockcroft), and Framingham risk scores before and after conversion.

Main Results:

• Significant improvements were observed in total cholesterol, LDL cholesterol, and triglycerides.
• Renal function (Cockcroft) showed significant improvement.
• No significant changes were detected in arterial wall properties or PWV.
• 24-hour ABPM remained unchanged, potentially due to long-term cyclosporine use.
• Framingham risk scores improved significantly only in patients not on statins.

Conclusions:

• Conversion from cyclosporine to tacrolimus in renal transplant recipients led to significant improvements in lipid profiles and renal function within 3 months.
• Contrary to the hypothesis, arterial wall properties and ABPM did not show significant changes, possibly influenced by the duration of prior cyclosporine therapy.