REMOVAL OF FK-506 BY CONTINUOUS HEMOFILTRATION - REPORT OF 2 ALLOGRAFT RECIPIENTS WITH RENAL AND LIVER FAILURES

We report the cases of 2 organ allograft recipients whose abnormally h igh FK506 plasma levels were successfully reduced by continuous hemofi ltration. The 1st patient, a renal allograft recipient, developed post -transplantation lymphoproliferative disease, liver failure and anuric renal failure during FK 506 rescue therapy. The 2nd patient, the reci pient of a bilateral lung and heart allograft, developed multiorgan fa ilure following repeated episodes of therapy-resistant hypotension. Th e plasma FK 506 concentrations in both patients remained elevated desp ite cessation of the drug for several days. In the first patient the F K 506 plasma concentration remained high despite 4 d of hemodialysis. During continuous hemofiltration of the 1st patient and continuous hem odiafiltration of the 2nd patient, the half-life of FK 506 in the plas ma decreased by a factor of 20 and 5 times, respectively. These cases suggest that continuous hemofiltration or hemodiafiltration may be eff ective in reducing toxic concentrations of FK 506 in the plasma. The 1 st case also implies that continuous hemofiltration may be a viable al ternative when hemodialysis fails to provide appropriate drug clearanc e.