Rescue therapy with tacrolimus after combined kidney/pancreas and isolated pancreas transplantation in patients with severe cyclosporine nephrotoxicity

Transplantation
S HariharanM R First

Abstract

This study details 11 pancreas transplant recipients (10 combined kidney and pancreas and 1 pancreas after kidney) who were converted to tacrolimus (FK506) due to acute severe cyclosporine nephrotoxicity in 8 cases and persistent rejection with cyclosporine toxicity in three cases. Arteriolopathy was documented by renal histology in all cases. Cyclosporine was discontinued for 24 hr immediately prior to initiation of tacrolimus. Tacrolimus was started orally at 0.1 mg/kg twice daily with dose adjustments to maintain whole blood trough levels of 8-15 ng/mL by IMx. Tacrolimus was initiated a mean of 14.5 months (range 1-81) after pancreas transplantation. The mean serum creatinine level had increased to 2.9 mg/dl from 1.0 mg/dl at the diagnosis of cyclosporine arteriolopathy (P=0.003). The mean serum creatinine and blood glucose levels at the time of initiation of tacrolimus were 2.1 mg/dl and 104 mg/dl, respectively. Serum creatinine was 1.7 mg/dl, 1.9 mg/dl, 1.8 mg/dl, and 1.7 mg/dl after 1, 2, 3, and 6 months of tacrolimus therapy, respectively; ANOVA (P = 0.02). The corresponding blood glucose levels were 117 mg/dl, 112 mg/dl, 109 mg/dl, and 116 mg/dl, respectively (P=NS). Normal C-peptide levels were present before (5.9 ng/m...Continue Reading

Citations

Mar 12, 1999·The Surgical Clinics of North America·A JainJ J Fung
Mar 19, 1999·Clinical Transplantation·R J Stratta
Jun 18, 2004·Transplantation·George W BurkeHans W Sollinger
Mar 6, 2002·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Ajay IsraniRoy Bloom
Mar 16, 2001·Expert Opinion on Pharmacotherapy·G CiancioJ Miller
Dec 12, 2012·Expert Opinion on Pharmacotherapy·Thomas Rath
Jun 2, 2000·Seminars in Dialysis·S Hariharan
Sep 30, 1999·The Journal of Pharmacy and Pharmacology·R YoshimuraS Wada

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