The Evolution of Immunosuppression With Fk506 in Pediatric Living-Related Liver Transplantation1

Abstract

The effects of three FK506 induction regimens on pediatric living-related liver transplantation (LRLT) were studied retrospectively in terms of patient survival and adverse side effects. The patients consisted of 120 children, ranging from 3 to 210 months of age, who underwent a total of 122 LRLTs with a minimum follow-up of 6 months. Immunosuppression consisted of FK506 and low-dose steroids. FK506 was given in 3 ways: (1) high-dose intravenous (i.v.) induction, with FK506 begun at a dose of 0.15 mg/kg/day for the first 16 patients; (2) low-dose i.v. induction, with FK506 begun at a dose of 0.06 mg/kg/day for the next 45 patients; and (3) per os (p.o.) induction, with FK506 begun orally from the day prior to LRLT and continued postoperatively. Whole-blood trough levels of FK506 were monitored daily. Trough levels in the high induction group were often as high as 100 ng/ml compared with the level of 20 ng/ml in the p.o. induction group. Patient survivals were 75%, 89%, and 80% in the high-i.v. vs. low-i.v. vs. p.o. groups. The incidences of acute rejection were 12.5%, 22.2%, and 26.4%, and the incidences of viral infection were 56%, 38%, and 11% in the respective groups. Major adverse effects occurred with higher frequency in the high-i.v. induction group. Oral FK506 induction therapy at a dose of 0.15 mg/kg/day starting from the day before LRLT was safer and associated with a lower incidence of viral infection than therapy with i.v. FK506.

Pattern of bacterial and fungal infections in the first 3 months after pediatric living donor liver transplantation: An 11-year single-center experience

“…9 The basic IS regimen consisted of tacrolimus and low-dose corticosteroid. 10 Target trough levels of tacrolimus in whole blood were 10-15 ng/mL in the first 2 weeks, and then 5-10 ng/mL during the first 2 months after LT. Methylprednisolone (20 mg/kg body weight) was administered intravenously (IV) during the anhepatic phase of surgery, followed by 2 mg/kg administered IV for the first 3 days, then tapered to 1 mg/kg for 3 days, and converted to 1 mg/kg/day of prednisone, which was weaned gradually and discontinued routinely after 6 months. In the case of rejection, a regimen of tacrolimus and steroid pulse was performed as described.…”

Long-term effects of liver transplantation on bone mineral density in children with end-stage liver disease: A 2-year prospective study

“…The patients were weaned off steroids with stable liver function at around 6 months after the transplantation. 4 All children had received 1-␣ hydroxyvitamin D3 at the oral doses of 0.4 to 0.6 g/kg/d in the follow-up period after the Kasai operation performed before transplantation. It was discontinued at least 1 month before transplantation and was not given after transplantation.…”

“…The patients were weaned off steroids with stable liver function at around 6 months after the transplantation. 4 All children had received 1-␣ hydroxyvitamin D3 at the oral …”

Untitled

“…In brief, tacrolimus and corticosteroids were used as the main immunosuppressants. 17,18 Additional immunosuppressive agents, such as azathioprine, mizoribine, or mycophenolate mofetil, were administered to inhibit humoral rejection or to decrease the doses of corticosteroids and tacrolimus whenever indicated. In case of rejection, tacrolimus and steroid pulse therapy were administered.…”