Cardiovascular risk factors after conversion from cyclosporine to tacrolimus in children after liver transplantation.

Abstract

Calcineurin inhibitors (CNI) may increase the risk of cardiovascular (CV) events. This prospective study aimed to determine cardiovascular risk factors in pediatric patients after living related liver transplantation (LRLTx) 12 months after the conversion from cyclosporine (CS) to tacrolimus (TAC). The study group consisted of 7 children (5 females and 2 males) after LRLTx performed at the median age of 3 years (range 0.8-7.2), who received CS monotherapy for at least 5 years before it was switched to TAC. The median age at conversion was years 13.1 years (range 10.1-18). Weight BMI Z-score, 24-h ABPM (ambulatory blood pressure monitoring), renal function assessment, and fasting lipid and oxidative stress profiles were performed before and 12 months after conversion. Within 1-year follow-up, TAC was well tolerated and we did not observe any drug-related adverse effects or severe infections. Renal function, blood pressure, and lipid parameters did not differ after the conversion. Before the conversion, there was lower median glutathione (GSH) levels (748 vs. 776 [µmol/l]) and glutathione peroxidase (GPx) activity (31.4 vs. 32.4 [U/gHb]), but statistical significance was not reached (p>0.05). Asymmetric dimethylarginine (ADMA) levels were higher before conversion to TAC (0.93 vs. 0.69 [µmol/l], p=0.01), as were oxidized LDL (oxyLDL) levels (317 vs. 264 [mU/ml], p=0.04). There was no significant difference between CS and TAC in risk factors for CV events. Potential benefits in oxidative stress profile resulting from CS to TAC conversion may add another important area for further research.