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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:1555-1558.)
© 1999 American Heart Association, Inc.

Thrombosis

Beneficial Effects of Conversion From Cyclosporine to Azathioprine on Fibrinolysis in Renal Transplant Recipients

Marinus A. van den Dorpel; Arie J. Man in't Veld; Marcel Levi; Jan Wouter ten Cate; Willem Weimar

From the Department of Internal Medicine I (M.A.D., A.J.M.V., W.W.), University Hospital Rotterdam, and the Department of Internal Medicine (M.L., J.W.C.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Correspondence to M.A. van den Dorpel, MD, PhD, Department of Internal Medicine, St. Clara Hospital Rotterdam, Olympiaweg 350, 3078 HT Rotterdam, The Netherlands.

Abstract—Cyclosporin A (CsA) has been implicated as one of the factors contributing to the high cardiovascular morbidity and mortality after renal transplantation. This may be mediated by either a high prevalence of conventional risk factors for atherosclerosis, such as hypertension, hypercholesterolemia, and diabetes mellitus, or by impairment of the fibrinolytic activity evoked by CsA, possibly through interference with prostanoid metabolism. We therefore assessed the impact of conversion of CsA to azathioprine immunosuppressive treatment on parameters of fibrinolytic activity and plasma concentration of the prostanoids prostaglandin E₂ and thromboxane B₂ in 18 stable renal transplant recipients. During CsA, mean arterial pressure and serum creatinine were significantly higher than during azathioprine (116±15 mm Hg versus 106±13 mm Hg, P=0.0003; and 147±34 µmol/L versus 127±35 µmol/L, P=0.002; mean±SD). On conversion, the plasma tissue plasminogen activator activity increased from 1.2 (1.1 to 1.7; median, 95% CI) to 1.8 (1.6 to 2.0) IU/mL (P=0.011), without a significant change of the plasminogen activator antigen concentration. This was associated with a substantial decrease in plasminogen activator inhibitor-1 activity from 10.4 (8.5 to 16.7) to 6.4 (5.6 to 9.2) IU/mL (P=0.009). Furthermore, plasma levels of prostaglandin E₂ and thromboxane B₂ markedly decreased (from 9.7 [7.4 to 12.9] to 4.6 [4.3 to 8.1] pg/mL, P=0.0006; and from 106.1 [91.7 to 214.2] to 70.2 [50.3 to 85.6] pg/mL, P=0.002, respectively). During CsA, but not azathioprine, plasma tissue plasminogen activator antigen and plasminogen activator inhibitor-1 levels correlated significantly with prostaglandin E₂ (r=0.53, P=0.02; and r=0.60, P=0.008, respectively), and thromboxane B₂ (r=0.75, P=0.0001; and r=0.77, P=0.0001, respectively) levels. In conclusion, CsA induced substantial impairment of fibrinolytic activity, which recovered after conversion to azathioprine. The impaired fibrinolysis observed during CsA treatment may be caused by modulation of eicosanoid production or metabolism in vascular endothelial cells and possibly contributes to the high incidence of cardiovascular disease after kidney transplantation.

Key Words: kidney transplantation • cyclosporin A • fibrinolysis • prostanoids

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