Conversion From Prograf to Advagraf in Stable Kidney Transplant Recipients: Better Renal Function After 3-Year Follow-up

Background. The complexity of treatment after solid organ transplantation has been related to non-adherence to therapy prescriptions and to reduced graft survival. The aim of this study was to evaluate the middle-term effects of the conversion from Prograf (TAC), to extended-release tacrolimus (Advagraf) (ADV) in stable kidney transplant recipients. Methods. Conversion from TAC to ADV (dose, 1:1 mg/mg) was planned in 78 kidney transplant patients with stable renal function 71 +/- 48 months after renal transplantation. Before conversion, 1 week after conversion, and every 6 months up to 3 years, patients were evaluated clinically and by means of the usual blood chemistry and pharmacologic parameters. Results. Twenty patients (26%) refused to change their pre-existing immunosuppressive therapy; therefore, 58 patients entered the study and 45 (77%) completed the 3-year follow-up. Patient survival was 98% and allograft survival was 96%. Significant reduction in serum creatinine levels and increased glomerular filtration rate were observed after conversion (3-year creatinine: before TAC 1.67 +/- 0.47 mg/dL vs after ADV 1.47 +/- 0.62 mg/dL, P < .001; glomerular filtration rate, MDRD abbreviated: before TAC 49 +/- 15 mL/min vs after ADV 59 +/- 24 mL/min, P < .001). The daily dose and CO blood levels of tacrolimus were stable before and after conversion (dose before vs 3 years after conversion: TAC 3.79 +/- 1.81 mg/day vs ADV 3.54 +/- 1.86 mg/day, P = ns; CO tacrolimus blood levels, before vs 3 years after conversion: TAC 6.03 +/- 1.75 ng/mL vs ADV: 5.58 +/- 1.38 ng/mL, P = NS). One patient in the ADV group had an episode of acute rejection (2%). Conclusions. Our data support the safety and efficacy of converting from Prograf to Advagraf in stable kidney transplant patients in the middle term. We suggest that the observed improvement in renal function after conversion to ADV is related to the reduction of the 24-hour tacrolimus area under the curve exposure.