Cardiovascular Risk Factors in Renal Transplant Patients after Switch From Standard Tacrolimus to Prolonged-Release Tacrolimus

Cardiovascular (CV) diseases are the leading cause of death after renal transplantation. Renal transplant patients present CV risk factors that correlate with renal function and the use of immunosuppressive drugs. Noncompliance with immunosuppressive therapy after organ transplantation increases the incidence of rejection, graft loss, and patient death. A simple posology regimen is the best way to promote compliance with prescribed therapy. To meet this need, a new formulation of tacrolimus that is suitable for once-daily administration, is now available on the market: prolonged-release tacrolimus (Fkpr). We analyzed changes in CV risk factors observed in renal transplant patients after transition from standard tacrolimus (Fk) to Fkpr and the rate of patients with the investigated parameters within the normal ranges before and after conversion. The study enrolled 40 Caucasian renal transplant patients (26 men and 14 women) who were being followed at our posttransplantation day hospital clinics. After a varying time interval after transplantation, patients on treatment with tacrolimus, mycophenolate + mofetil (MMF), and steroid entered a 12-month observation period. Thereafter, they were switched to Fkpr, also in association with MMF and steroid, and were observed for a further 12-month period. The following parameters were tested in all patients: creatinine, creatinine clearance, insulin resistance, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, uric acid, homocysteine, and urine magnesium. The switch from Fk to Fkpr showed an improvement of the parameters investigated. Moreover, the proportion of patients with normal laboratory values after the transition from Fk to Fkpr was noted either to increase or to remain stable at the improved levels observed during therapy with Fk. Immunosuppressive treatment with Fkpr represents an even better option than Fk for renal transplant patients, because by reducing CV risk factors it favorably affects the long-term outcomes for graft and patient.