FK506 RESCUE FOR RESISTANT REJECTION OF RENAL-ALLOGRAFTS UNDER PRIMARY CYCLOSPORINE IMMUNOSUPPRESSION

Seventy-seven patients with ongoing acute rejection on initial CsA the rapy were converted to FK506 to attempt graft salvage. Fifty-nine pati ents had undergone primary transplantation and 18 had been retransplan ted; there were 52 cadaveric and 25 living-donor transplants. The indi cations for conversion to FK506 were ongoing, biopsy-confirmed rejecti on in all patients, including vascular rejection in 20. The median int erval to rescue was 2 months (range 2 weeks to 36 months) after transp lantation. Sixty-one of the 77 patients (79%) had already received one or more courses of an antilymphocyte preparation (OKT3: n=33; ALG or ATG: n=1; OKT3+ALG/ATG: n=27). Of the 77 patients, 57 (74%) have been successfully rescued and still have functioning grafts with a mean fol low-up of 14 months, with a mean serum creatinine of 2.35+/-0.97 mg/dl . Eighteen patients were already dialysis-dependent at the time of con version to FK506; of these, 9 (50%) were successfully salvaged and hav e a mean serum creatinine of 2.3 mg/dl. Of the 61 patients previously treated with antilymphocyte preparations, 48 (79%) were rescued. In th ose salvaged, prednisone doses have been lowered from 22.2+/-7.2 mg/da y preconversion to 7.5+/-5.6 mg/day postconversion, and 12 patients ar e on FK506 monotherapy. In nondiabetics, mean serum glucose was 101.4/-20.5 mg/dl preconversion and 93.2+/-22 postconversion (P=0.07), uric acid 7.3+/-2.3 and 7.1+/-1.5 mg/dl (P=0.53), and triglycerides 199.2/-101.6 and 167.2+/-106.4 mg/dl (P=0.06). Cholesterol levels were sign ificantly lower following FK conversion (207.7+/-46.5 mg/dl pre. vs. 1 88.3+/-39.7 post., P=0.007). FK506 is capable of salvaging renal allog rafts with ongoing acute rejection on CsA therapy, even when antilymph ocyte preparations have been ineffective.