Differential effects of cyclosporine and tacrolimus on arterial function

Cardiovascular complications are the leading cause of death in renal transplant recipients and constitute one of the leading causes of graft failure. Calcineurin inhibitors (CNI) induce an acceleration of atherosclerotic processes in the arterial wall. There are conflicting data whether cyclosporine A (CsA) and tacrolimus (Tac) differ in their deleterious effects on arterial stiffening. The present study combines several measurement techniques to provide a global and reliable assessment of the differential effects of CNI on the gold-standard parameters of arterial function. Pulse wave analysis was performed by the SphygmoCor (AtCor(®) ), HEM-9000AI (Omron(®) ), and CR-2000 device (Hypertension Diagnostics(®) ) in 56 stable renal transplant recipients (29 CsA, 27 Tac). Groups were homogeneous for age, gender, body mass index, time on dialysis prior to transplantation, and graft function. Whereas systolic and diastolic blood pressure, central aortic blood pressure, cardiac index, large and small artery compliance index (C(1) and C(2) ), and pulse wave velocity did not significantly differ between CsA and Tac, augmentation index (AI(75) ) was significantly lower in patients treated with Tac. This finding was consistent as assessed by two different measurement systems (P < 0.05). Compared to CsA, Tac has a favorable impact on augmentation index, a strong independent predictor for cardiovascular mortality.