Tacrolimus (FK506) for Rescue Therapy of Refractory Renal Allograft Rejection.
- Author:
Hyuk Jai JANG
1
;
Song Cheol KIM
;
Duck Jong HAN
Author Information
1. Department of Surgery, University of Ulsan College of Medicine, Korea.
- Publication Type:Original Article
- Keywords:
Tacrolimus;
Refractory rejection therapy
- MeSH:
Allografts*;
Aspergillosis;
Biopsy;
Creatinine;
Cytomegalovirus;
Diabetes Mellitus;
Esophagitis;
Follow-Up Studies;
Hemorrhage;
Humans;
Immunosuppression;
Pneumonia;
Pneumonia, Pneumocystis;
Purpura, Thrombocytopenic;
Tacrolimus*;
Transplants;
Tremor
- From:The Journal of the Korean Society for Transplantation
1999;13(1):101-108
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Over the 1 year 3 month period from 7/11/1997 until 10/30/1998, we have attempted graft salvage with tacrolimus conversion in a total of 11 patients (mean age 41 years, range 31~64 years) with ongoing rejection on baseline CsA immunosuppression after failure of high dose corticosteroid to reverse rejection. The indications for conversion to tacrolimus were ongoing biosy confirmed rejection in all patients. Seven grafts showed vascular rejection and 4 had cellular rejection on biopsy. The median interval to tacrolimus conversion was 4 days (range 1 days to 840 days) after transplantation. Three patients (27.3%) were dialysis-dependent owing to the severity of rejection. All patients (100%) have been successfully rescued and graft function of the patients improved from an average serum creatinine level of 7.3 3.6 mg/dl to 1.4 0.5 mg/dl. During the mean follow-up of 8.1 months after conversion, there were 10 complications following tacrolimus conversion including cytomegalovirus (CMV) infection in 2 patient, herpes esophagitis in 1, aspergillosis pneumonia in 1, pneumocystis carinii pneumonia in 1, new-onset diabetes mellitus in 4, tremor in 1 and bleeding due to thrombocytopenic thrombocytopenic purpura (TTP) in 1. Two of these postconversion complications resulted in patient death. Treatment with tacrolimus may successfully suppress ongoing acute rejection, even if high dose corticosteoid treatment have failed to reverse rejection. Base on these data, we recommend that tacrolimus be used for refractory rejection therapy. An additional anti-infective prophylaxis seems to be necessary in preventing severe complications after rejection therapy.
