Substitution of
cyclosporin with
tacrolimus should be considered for paediatric
liver transplant recipients with
cyclosporin-associated complications such as
hypertension, gum
hyperplasia,
hirsutism, gynaecomastia and growth retardation, as well as recurrent or refractory acute rejection, chronic duct injury or chronic rejection. Continued experience with well tolerated
drug administration and careful monitoring during
drug substitution has limited
drug toxicity associated with
tacrolimus to a level comparable to or less than that associated with
cyclosporin. Successful outcome with long term graft salvage has been reported in up to 80% of patients converted to
tacrolimus because of acute rejection and 50% of patients converted because of chronic rejection. Nearly all children converted because of
cyclosporin-related complications have a successful outcome. Additional benefits of conversion to
tacrolimus include improvement in growth and resolution of
hypertension,
hirsutism and cushingoid
facies. Complete
corticosteroid withdrawal is possible in up to 78% of children post-conversion. Long term outcome in these patients may be optimised by conversion to
tacrolimus at an early stage of acute or chronic transplant rejection in order to minimise the cumulative amount of immunosuppression. Avoidance of
cyclosporin-related toxicity and minimisation of
corticosteroid therapy may further improve patient compliance to
drug therapy.