Tacrolimus for primary treatment of steroid-resistant hepatic allograft rejection.

摘要: Twelve patients who experienced steroid-resistant rejection after primary liver transplantation while receiving cyclosporine-based therapy were converted to tacrolimus without OKT3 or additional steroids. The indications for conversion ongoing biopsy-confirmed rejection. All had received one course of high-dose intravenous steroids, which failed reverse the episode. No other antirejection was given. Tacrolimus initiated and maintenance therapy. target level 15-20 ng/ml (whole blood, IMX). 12 rapid reversal episode did not experience recurrent (mean follow-up: 8.2 +/- 1.2 months). mean bilirubin dropped from 6.1 mg/dl at initiation 4.4 by day 7 therapy, 2.5 14, 1.5 21 (P 4 months are no longer steroid is effective as treatment provides a sustained biochemical response. Patients with mild moderate may be safely cyclosporine an bolus Early "preemptive" prior use steroids decrease overall requirements. This approach has promise improved graft survival fewer infectious immunologic complications.