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Conversion from Tacrolimus to MMF

Posted: Tue Jan 07, 2020 11:47 am
by morzov
Hello All

I am 13 years post transplant (live donation from my dear wife) and my results have been very stable up until recently when my creatinine has begun to creep up from 130 to 170.

My consultant has recommended that I need to transition from tacrolimus (I am currently on a fairly low dose - 1mg x2 per day plus 5mg prednisilone) onto MMF because of the nephrotoxicity of tacrolimus in the long term.

I was wondering if anyone had a similar experience and if so how things went??

Re: Conversion from Tacrolimus to MMF

Posted: Sat Jan 11, 2020 6:59 pm
by morzov
Was expecting some answers but presumably no one who has read the post has had this experience.

Thing is I need to make a decision on this fairly quickly so maybe I should rephrase the question and ask if anyone is aware of this change from tacrolimus to MMF?

Thanks in advance.

Re: Conversion from Tacrolimus to MMF

Posted: Sun Jan 12, 2020 5:25 pm
by wagolynn
I would go with what the consultant recommends, he/she will be doing what is best for you.

If things don't feel right, report back to the consultant at once.

Re: Conversion from Tacrolimus to MMF

Posted: Wed Jan 15, 2020 8:42 am
by Rik
Hi Morzov ...
apologies for not replying sooner ...
sounds like we are in a similar situation with changing to MMF
I'm UK based ... 16 1/2yrs Tx and because of my size (6'4" and 100-ish kg) my creatinine sits around 130-150
I used to take 2.5mg of Tac (I take the once a day slow release Advagraf not the two doses a day Tacrolimus)
and 5mg pred ...
a couple of years back my Prof wanted me to go onto MMF 1g a day ...
but not to change from Tac but to stop my Pred
I would go with it as Wagolyn suggests
I have had no adverse reaction to the MMF ... I still take my Advagraf
but because of bouts of gout every time I tried coming off of Pred I have only managed to reduce my pred not come off it completely
but with a change of anti gout tablets recently I reckon I'll be Pred free by summer
hope that helps

Re: Conversion from Tacrolimus to MMF

Posted: Fri Jan 17, 2020 2:31 pm
by morzov
Thanks for the replies.

Rik - as I read your post you are not being taken off tacrolimus, rather you are staying on it and MMF is being used instead of pred?

Apologies but I probably didn't make clear in my case my Tacrolimus is being replaced by MMF and I'm staying on pred 5 mg per day so that seems to be a completely different protocol.

The reason given to me for the change is that Tacrolimus is ultimately toxic to the TX but from your post Rik it doesn't look like that was the reason for the change in meds.

Re: Conversion from Tacrolimus to MMF

Posted: Fri Jan 17, 2020 3:17 pm
by Rik
Hi Morzov ...
no problem made yourself perfectly clear ... Tac being replaced by MMF

my Prof was more concerned about me being on a steroid for so long ...
for now that's more important I assume ...
I believe now it's normal to start a steroid free regime with their new Tx

I think either way ... you need to talk your concerns through with your team ...
make notes and ready questions you want to ask when you go next ...
make notes of the answers and say you want more time to consider the changes
you have had the Tx for this long ... a month or six more will make no difference when making your decision
do you take the Tac in two seperate doses or like me the slow release once a day?
I've looked back and changing from twice daily to single dose has been one of your previous questions ...
which one did you go for in the end?
what's the difference in their toxicity to ones body long term... if any? ...

I had no problem with the idea of stopping the pred ...
I would want far more info about why they want me to stop my Tac first instead of my Pred ...
hope that helps

Re: Conversion from Tacrolimus to MMF

Posted: Fri Jan 17, 2020 4:55 pm
by morzov
Thanks Rik

I have of course discussed this extensively with my consultant but I posted to get some real world experience. I wanted to see who else had done this and how it had worked out.I also wanted to see if some people had not done this but had continued with good function anyway by staying on Tacro.

I wasn't expecting the answer you gave and whilst I'm in no rush to experience the pain of gout again!, getting off pred seems a good thing to me. I hope it works out.

A couple of final points:

- I wasn't offered the opportunity to take a once a day tacrolimus but I have been stable for the last 4 months on a dose of 2 x 1mg per day
- I did reduce my pred dose very early on from 7.5mg to 5 mg per day. I was advised against it but the doctors did accept my view and after a gradual reduction in dosage there was no deterioration in kidney function. They did however strongly recommend against reducing pred to zero even though as you rightly say it is seldom now used long term for new TX patients.