Intentional conversion from tacrolimus to cyclosporine for HCV-positive patients on preemptive interferon therapy after living donor liver transplantation
Susumu Eguchi, MItsuhisa Takatsuki, Akihiko Soyama, Masaaki Hidaka, Hirotaka Tokai, Koji Hamasaki, Kensuke Miyazaki, Yoshitsugu Tajima, Tatsuki Ichikawa, Takashi Kanematsu
Ann Transplant 2007; 12(4): 11-15
Background: Recently we reported that signal transmission of interferon is more suppressed by tacrolimus (Tac) than cycrosporine (CyA). Therefore, although CyA might be beneficial immunosuppressive drug after liver transplantation (LT) on interferon therapy against hepatitis C virus, it is hesitated because of the risk for provocation of rejection. Herein initial outcome of our strategy, i.e. intentional conversion from Tac to CyA during preemptive interferon therapy after living donor LT (LDLT) was reported.
Material/Methods: Of 62 patients who had undergone LDLT in Nagasaki University Hospital between 1997 and November 2006, 16 patients showed indications for hepatitis C-related liver cirrhosis. The median follow-up period was 15 months. Tac was used for all patients as induction therapy combined with steroids tapering.
Results: In 11 out of 16 cases (68.8%), preemptive Pegylated (Peg)-IFN-α 2b+Ribavirin therapy was initiated. When Peg-IFN-α 2b+Ribavirin therapy was commenced, Tac-to- CyA conversion was done. The median period of conversion from Tac to CyA was 1.5 month after LDLT. After the conversion, ACR occurred in one case. Out of 11 patients, 3 patients (21.4%) showed early viral response (VR) at 3 months, 2 showed end-treatment response at 48 weeks (14.3%) and 3 showed sustained VR (21.4%).
Conclusions: Intentional conversion from Tac to CyA can be safely performed without increasing the risk of ACR.
Keywords: living donor liver transplantation, conversion, Immunosuppression