EXPERIMENTAL AND CLINICAL-EXPERIENCE WITH THE USE OF TACROLIMUS (FK506) IN KIDNEY-TRANSPLANTATION

Tacrolimus is a recently developed immunosuppressive agent, based on a mechanism similar to cyclosporin. A broad variety of trials has provi ded evidence for its efficacy in human liver transplantation. In these trials, the incidence of acute rejection was markedly reduced. The fo llowing article reviews recent knowledge regarding clinical and experi mental experience with tacrolimus in kidney transplantation. In summar y, clinical trials suggested a marked reduction of acute allograft rej ections comparable to those observed in liver transplantation. Its eff icacy in steroid-resistant rejections is also well documented, while n ot critically analyzed in a prospective trial. Its effect is independe nt of the preceding administration of antilymphocyte antibodies. Thus, its use seems warranted even in the presence of steroid-resistant gra ft rejection, when treatment with antilymphocyte antibodies is contrai ndicated. Based on preliminary experience with tacrolimus in previous studies of primary immunosuppressive treatment and on the compelling e vidence that the drug is effective in rescue therapy, its use as prima ry immunosuppressive regimen in immunologic high risk patients should now be considered.