Tacrolimus rescue therapy for children with acute renal transplant rejection

Seventeen children with renal transplants (11 living-related, age 2-18 years) were converted from cyclosporine to tacrolimus because of acute rejection that failed to respond to high-dose corticosteroids. Resistance to corticosteroids was confirmed by renal biopsy in 14 patients, and assumed in 3 pa...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2001-12, Vol.16 (12), p.990-992
Main Authors: HYMES, Leonard C, WARSHAW, Barry L
Format: Article
Language:English
Subjects:
Acute Disease
Adolescent
Biological and medical sciences
Biopsy
Cadavers
Child
Child, Preschool
Creatinine
Cyclosporine - therapeutic use
Diabetes
Drug Resistance
Glucocorticoids - therapeutic use
Graft Rejection - complications
Graft Rejection - drug therapy
Graft Survival
Humans
Immunomodulators
Immunosuppressive Agents - therapeutic use
Kidney diseases
Kidney Transplantation
Kidney transplants
Medical sciences
Methylprednisolone - therapeutic use
Patients
Pharmacology. Drug treatments
Retreatment
Retrospective Studies
Salvage Therapy
Steroids
Tacrolimus - therapeutic use
Treatment Outcome
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Summary:Seventeen children with renal transplants (11 living-related, age 2-18 years) were converted from cyclosporine to tacrolimus because of acute rejection that failed to respond to high-dose corticosteroids. Resistance to corticosteroids was confirmed by renal biopsy in 14 patients, and assumed in 3 patients because of failure of serum creatinine to improve to baseline values. Four patients were also treated with OKT3, and 15 children had been receiving mycophenolate maintenance therapy prior to conversion to tacrolimus. Rejection occurred at 2-174 weeks post transplant (mean 52 weeks). Actuarial 1- and 2-year graft survival was 87% and 78%. Three children progressed to end-stage renal disease after 4, 12, and 13 months of tacrolimus. The remaining 14 children have functioning allografts after 20-168 weeks of treatment (mean 80 weeks). All 14 children exhibit stable or improved renal function: serum creatinine 1.1+/-0.7 mg/dl versus 2.0+/-0.9 mg/dl prior to tacrolimus. In conclusion, tacrolimus was effective therapy for both early and late acute rejection in children who failed to respond to high-dose corticosteroids. No significant short-term adverse effects were encountered.
ISSN:0931-041X
1432-198X
DOI:10.1007/s004670100010