Hypertension, metabolic derangements and renal dysfunction in renal transplant patients using cyclosporine or tacrolimus

Resumen

Purpose: To assess metabolical and hypertension adverse events and renal function outcomes in patients with renal transplant receiving neoral cyclosporin or tacrolimus in an outpatient service in Brazil. Methods: All consecutive patients with renal transplant performed at Hospital Alemão Oswaldo Cruz between March 2000 and December 2003 were enrolled. Patients were divided in groups I with 24 patients taking tacrolimus and II with 23 patients taking neoral cyclosporin. It was compared their metabolical and hypertension adverse events and renal function outcomes. Results: Both groups presented comparable outcomes at baseline related to age, gender, race, end-stage renal disease and weight. Serum total cholesterol (186.6 ± 42 x 244.1 ± 48.1 p= 0.002; mg/dl), low-density lipoprotein (LDL) cholesterol (98.01± 23.3 x 153.2 ± 41.5 p= 0.011; mg/dl) and triglyceride (181.2 ± 91.1 x 292.5 ± 258.1 – p= 0.012; mg/dl) were significantly lower in patients receiving tacrolimus than those on cyclosporin. The antihyperlipidaemic medication to control lipid levels required by the cyclosporin group was strongly greater (70 vs 26%, p=0.04). Significantly more patients on cyclosporin than on tacrolimus presented hypertension (60 vs17%, p= 0.009). Post-transplant diabetes mellitus frequency showed no difference between groups (24.1 vs 16.6%). The serum creatinine level at the third month of tacrolimus treated patients was significantly lower than the cyclosporin treated patients (1.15  0.21 vs 1.40  0.38; p=0,009). Conclusion: Patients receiving maintenance immunosuppression with tacrolimus as opposed to ciclosporin present better renal function and reduced cardiovascular risk factors.