Tacrolimus rescue therapy for children with acute renal transplant rejection |
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Authors: | L C Hymes B L Warshaw |
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Institution: | (1) 2040 Ridgewood Drive, N.E., Atlanta, GA 30322, USA. Lhymes@emory.edu, US;(2) Department of Pediatrics, Division of Nephrology, Emory University, Atlanta, Georgia, USA, US |
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Abstract: | 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.
Received: 29 August 2000 / Revised: 31 July 2001 / Accepted: 31 July 2001 |
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Keywords: | Tacrolimus Cyclosporine Corticosteroids Renal transplantation Acute rejection |
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