PMID: 7541834Apr 1, 1995Paper

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

Journal of Pediatric Gastroenterology and Nutrition
S V McDiarmidR W Busuttil

Abstract

We report our experience in 17 pediatric orthotopic liver transplant (OLT) patients converted from cyclosporine (CsA) to FK506 for intractable acute and chronic rejection. FK506 was initiated orally at a dose of 0.3 mg/kg/day in most patients; the dose was then adjusted to achieve serum levels of 0.5-1.5 ng/ml. Azathioprine was discontinued and low-dose prednisone maintained. The median time between liver transplantation and FK506 conversion was 41 months. Patients have been treated for an average of 14.8 +/- 9.6 months. Six patients were converted for acute rejection and 11 for chronic rejection, i.e., vanishing bile duct syndrome (VBDS). After FK506 conversion, the actual patient and graft survival was 88% and 82%, respectively, in the group as a whole. Two patients died, one of chronic active hepatitis C and the other of lymphoma. Three patients, all with VBDS, did not respond to FK506 and therefore required retransplantation. The serum bilirubin is currently normal in 14 patients and the serum transaminases < 100 IU/ml in 12. The mean bilirubin pre-FK506 of patients successfully converted to FK506 was 4.2 mg/dl compared to 11.8 mg/dl in patients who failed conversion. Major complications included nephrotoxicity, neurotoxici...Continue Reading

Citations

Sep 10, 1998·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·M CharltonJ Hoofnagle
Jun 24, 1998·Transplantation Proceedings·B KrügerW Riegel
Jun 24, 1998·Transplantation Proceedings·S McDiarmidR Busuttil
Oct 26, 2000·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·R SreekumarM R Charlton
Oct 1, 1996·Journal of Pediatric Gastroenterology and Nutrition·A BousvarosA M Leichtner
Jan 27, 1998·Journal of Pediatric Gastroenterology and Nutrition·S V McDiarmid
Apr 30, 2003·Journal of Pediatric Gastroenterology and Nutrition·Maria M Oliva-HemkerHoward M Lederman
Nov 28, 2002·Pediatric Transplantation·Raymond Reding
Nov 24, 2007·BioDrugs : Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy·G V MazariegosJ Reyes
Jan 17, 2003·Paediatric Drugs·Dominique DebrayChristophe Chardot
Mar 10, 2001·Clinics in Liver Disease·O Abramson, P Rosenthal
Mar 30, 2002·Transplantation·Ashok JainJorge Reyes
Nov 28, 2002·Pediatric Transplantation·R D Holmes, R J Sokol
Dec 13, 2000·The Journal of Pediatrics·A BousvarosA M Leichtner
Mar 10, 2001·Clinics in Liver Disease·S V McDiarmid

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