The treatment of intractable rejection with tacrolimus (FK506) in pediatric liver transplant recipients

摘要: We report our experience in 17 pediatric orthotopic liver transplant (OLT) patients converted from cyclosporine (CsA) to FK506 for intractable acute and chronic rejection. was initiated orally at a dose of 0.3 mg/kg/day most patients; the then adjusted achieve serum levels 0.5-1.5 ng/ml. Azathioprine discontinued low-dose prednisone maintained. The median time between transplantation conversion 41 months. Patients have been treated an average 14.8 +/- 9.6 Six were rejection 11 rejection, i.e., vanishing bile duct syndrome (VBDS). After conversion, actual patient graft survival 88% 82%, respectively, group as whole. Two died, one active hepatitis C other lymphoma. Three patients, all with VBDS, did not respond therefore required retransplantation. bilirubin is currently normal 14 transaminases < 100 IU/ml 12. mean pre-FK506 successfully 4.2 mg/dl compared 11.8 who failed conversion. Major complications included nephrotoxicity, neurotoxicity, glomerular filtration rate (GFR) 97 29 mls/min/1.73m2 prior dropped 51 20 (p = 0.0001) after 13.6 months therapy. developed B-cell lymphomas; two them responded decreased immunosuppression died. conclude that children reversed if instituted before cholestasis becomes pronounced.(ABSTRACT TRUNCATED AT 250 WORDS)