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Two year experience with FK506 in pediatric patients

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  • Medicine


":.w , . NEW IMMUNOSUPPRESSIVE AGENTS Two-Year Experience With FK 506 in Pediatric Patients A.G. Tzakis. J. Reyes, S. Todo, B. Nour, R. Shapiro, M. Jordan, J. McCauley, J. Armitage, J.J. Fung, and T.E. Starzl THE ENTIRE pediatric experience with FK 506 be-tween September 1989, when the drug was intro- duced at Children' s Hospital of Pittsburgh, and October 1991 is presented. Follow-up is to August I. 1992. THERAPEUTIC PRINCIPLES The starting dose of FK 506 has been kept the same in the pediatric population as when the drug was introduced: 0.15 mglkgld IV as a continuous infusion and 0.15 mglkg bid orally. 1 The dose was increased in case of rejection if the trough serum FK 506 level was <2 ng/mL and there was no nephrotoxicity. The dose was decreased in the absence of rejection if the serum FK 506 level was > 3 ng/mL or if there was nephrotoxicity. The doses. including starting dose. were lower in the presence of liver dysfunction. as in liver rescue attempts. Prednisone Prednisone was administered at 20 mg/d for larger children or 10 mg/d for smaller children « 10 kg body weight). It was tapered and then discontinued when the graft function was stable. In kidney and intestinal transplantation, pred- nisone starting at 200 mg/d for larger children and 100 mg/d for smaller children was used. The dose was tapered to 20 mg/d and 10 mg/d, respectively, within 5 days. Freedom from Steroids Of 147 patients who received primary transplantation. and are alive with functioning grafts. 126 (86%) are steroid-free (93% of liver recipients. 41% of cadaveric kidneys, 71% of living related. 82% of heart. 33% of lung, 75% of liver- intestine. 100% of solitary intestine). Of 57 patients whose grafts were successfully rescued. 40 (70%) are steroid-free (liver 82%. kidney 20%. heart 100%. lung 100%). Azathioprine Courses of azathioprine (1 to 2 mg/kg/d) were used as supplemental immunosuppression mainly in cases of renal impairment. Twelve primary transplant

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