switch from cyclosporine to sirolimus

Close to five years post liver transplant. No rejections, cyclosporine mono -therapy .Also take 300 mg ursodiol 3x daily for bile duct stricture. Vascular hyper-tensions are becoming a real concern. ie heart, palpitations . fluid in ears , vision problems that aren't related to my actual eyes, the opthamologist confirmed, Migraines that have actually gotten better lately. kidney function is still adequate. My liver is doing very good especially with hep-c.. My concern is whether the rest of me will make it a lot longer with this same regiment. Is switching to sirolimus something to seriously consider? Does it use bile acid to metabolize making it a bad match with someone having to rely on ursodiol to keep bile presumably flowing adequately? My bilirubin avg lately 1.3. Docs have my cyclosporine about as low as they can go .THANK YOU DR. SHIANO YOUR AWESOME.

[Thomas D Schiano, MD]

this far out from liver transplant, i do not think the lowering will post a problem.  this is a standard way of tapering the cyclosporine.  rapa doesnt affect bile flow as far as i know.

[Thomas D Schiano, MD]

my first suggestion would be whether they could decrease your cyclosprine a little bit more.  My personal bias is to not switch the immunosuppressive agent.  rapamune can be difficult to tolerate.  i am happy to hear that your renal function is OK.  i think you will continue to do OK

[Bill200]

Why are you biased against switching immunosuppressent?  Might'n one work better that the other as far as sides and hcv affect go?

Also how long does the patient normally stay on two immunosuppresents after transplant?

[Thomas D Schiano, MD]

there is also a risk of precipitating rejection when switching immunosuppressive agents.  there is some early data to suggest that rapa may have a better effect on HCV replication though.

[stan50]

My last cyclosporine through level was 76. My doctors are going to lower cyclo from 100 mg twice daily to 75 mg twice daily . I thought they would lower it gradually 100 mg day 75 mg night. then after sometime and blood work go to 75mg  twice daily if every thing checked out. I am scared to lower my rejection meds. I have never had any rejection. Should i be trying to lower my rejection meds with a through level of 76? do you have any patients on rapa? Does rapa affect bile flow? Thank you Dr. Schiano

[Thomas D Schiano, MD]

i think this is a reasonable way of lowering the cyclosporine dose and as long as labs are being followed regularly i think that this is OK.  I am not aware of rapa affecting bile flow.