INITIAL EXPERIENCE WITH TACROLIMUS RESCUE THERAPY IN OKT3 RESISTANT REJECTION

Follow-up of 9 renal transplant recipients who were converted from cyc losporin A to tacrolimus (FK506) as recue therapy for intractable reje ction is described. All patients initially received a cyclosporin A ba sed immunosuppression. They developed biopsy proven acute rejections 2 2 +/- 11 days after transplantation which did not resolve by i.v. ster oids and subsequent OKT3. Fifty-three +/- 11 days post transplantation the patients were converted from cyclosporin A to tacrolimus. After c onversion to tacrolimus 6 patients developed a stabile transplant func tion. One transplant recipient who initially responded to tacrolimus l ost his graft due to a chronic rejection 9 months following conversion . Two patients with never functioning kidneys remained on dialysis des pite tacrolimus therapy. After conversion no serious adverse events oc curred and only a slightly increased infection rate and hyperglycemia were noted as major side effects of tacrolimus. Tacrolimus rescue ther apy was effective in treating acute renal allograft rejection unrespon sive to steroids and OKT3. Tacrolimus rescue therapy was not accompani ed by a substantial rise in complications. Patients with never functio ning kidneys did not seem to benefit from tacrolimus rescue therapy.