Although
cyclosporine (CsA)-based immunosuppressive regimens have been highly successful in
renal transplantation in infants and children, their adverse influence on somatic growth, general appearance, and blood pressure are of particular importance in this population. Over the past 4 years, we have utilized
tacrolimus (formerly FK-506) as the primary
immunosuppressive agent in 43 unselected children and achieved 1-year and 3-year allograft survival rates of 96% and 85%, respectively. We have also used
tacrolimus to rescue 14 of 19 (74%) renal allografts from CsA-resistant rejection.
Corticosteroids were discontinued in 62% of non-rescue patients without increasing the risk of rejection or renal dysfunction over a mean follow-up time of 25 months.
Tacrolimus monotherapy has been associated with improved body growth and less
obesity, while
tacrolimus alone or in combination with
prednisone was virtually free of
hirsutism or
gingival hypertrophy, and posed a low risk for
hypertension. A major disadvantage of this regimen may be an increased risk for
viral infections and a benign form of posttransplant lymphoproliferative disease. This article describes the
tacrolimus protocol utilized in our center and focuses on practical clinical issues including therapeutic monitoring, benefits, and major toxicity in children with renal allografts.