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Improved renal allograft survival in children treated with FK 506 (tacrolimus) rescue therapy
H E Corey1, V Tellis, R Schechner
1Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
Insights
FK 506 (tacrolimus) rescue therapy effectively reversed acute renal allograft rejection in children. This immunosuppressive treatment demonstrated improved long-term graft survival rates compared to historical controls.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Acute renal allograft rejection is a significant challenge in pediatric transplantation.
- Steroids and OKT3 are standard treatments, but some rejections are resistant.
- The long-term impact of FK 506 (tacrolimus) as a rescue therapy is not well-established.
Purpose of the Study:
- To evaluate the efficacy of FK 506 rescue therapy in pediatric renal allograft recipients.
- To determine the impact of FK 506 on long-term graft survival in this population.
Main Methods:
- Retrospective analysis of 23 pediatric renal transplant recipients transplanted between January 1993 and December 1994.
- Ten patients received FK 506 rescue therapy for acute rejection.
- Graft survival and rejection reversal rates were assessed with a mean follow-up of 10.9 months.
Main Results:
- Acute rejection was reversed in 80% (8 of 10) of patients receiving FK 506 rescue therapy.
- Seven of these grafts remained functional at the end of the follow-up period.
- The actuarial 1-year graft survival rate was 86% for FK 506 treated patients versus 66% for historical controls (P < 0.05).
Conclusions:
- FK 506 rescue therapy can successfully reverse acute renal allograft rejection resistant to other treatments.
- This therapy may offer significant long-term benefits for graft survival in pediatric renal transplant recipients.
- FK 506 represents a valuable option for managing difficult-to-treat acute rejection episodes.
Abstract:
FK 506 has been reported to be effective in reversing acute renal allograft rejection that is resistant to steroids and to OKT3. The contribution of FK 506 "rescue" therapy to long-term graft survival has not been determined. We report 23 children transplanted between January 1993 and December 1994, 10 of whom received FK 506 "rescue" therapy. Acute rejection was reversed in 8 of 10, with 7 of the remaining grafts still functioning after a mean follow-up of 10.9 +/- 7.8 (SD) months (range 1-26 months). The actuarial 1-year graft survival rate was 86% compared with 66% for historical controls (P < 0.05). We conclude that FK 506 may provide long-term benefits to children facing allograft loss due to acute rejection.