Reducing Tacrolimus Levels to Improve Cognitive Function in Kidney Transplant Recipients

What is it about?

Chronic kidney disease (CKD) is associated with decline in cognitive function. The prevalence of cognitive impairment in patients with CKD is higher in older patients with end-stage kidney disease.2 Cognitive impairment in kidney transplant recipients is viewed as a clinically relevant problem that is often underestimated.3 Despite the improvement in cognitive function after kidney transplantation, average cognitive performance remains below that of the non-CKD population. It is possible that immunosuppressive medications hinder cognitive function improvement after kidney transplantation. Although uncertain, it is possible that calcineurin inhibitors-induced vasoconstriction contributes to cognitive impairment.7_x000D_ In the current issue of Kidney360, Tariq et al.9 reported an open label, single center, prospective pilot study of 39 kidney transplant recipients with stable allograft function on high dose immediate release tacrolimus and an anti-metabolite, with or without prednisone. Patients in the intervention group were started on everolimus, tacrolimus was reduced from a trough level of 7-10 ng/mL to 3-5 ng/mL, and the antimetabolite was stopped. There was an increase in cerebral blood flow across different brain regions and an improvement in cognitive function. Immunosuppression optimization may be a promising strategy to improve cognitive function after kidney transplantation but needs to be carefully balanced against the risk of rejection and renal graft function decline._x000D_ _x000D_

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