TACROLIMUS RESCUE THERAPY IN PATIENTS WITH REJECTION AND LONG-TERM DIALYSIS AFTER KIDNEY-TRANSPLANTATION

Therapy with tacrolimus has been proven effective in patients with ste roid-resistant rejection episodes. It was the objective of the present study to evaluate the efficacy of tacrolimus in patients with long-la sting primary or secondary non-function (defined as being on dialysis for at least 28 days) converted for biopsy proven acute rejection and to determine parameters of prognostic value. Eight patients with biops y proven acute interstitial rejection unsuccessfully treated with ster oids were converted from a cyclosporine based immunosuppressive regime n to tacrolimus. Three patients were additionally pretreated with OKT3 without success, The tacrolimus whole blood through level was 7.5 +/- 2.6 ng/ml at one week and 8.1 +/- 3.4 ng/ml at one month after conver sion. The follow-up period after conversion to tacrolimus ranged from 12-18 months, In four patients hemodialysis was stopped after 78 +/- 4 9 days (range 36-145 days). One year thereafter, creatinine was 3.9 +/ - 2.7 mg/dl. In conclusion, our observations, although obtained In a s mall number of patients, offer some hope in this selected group and ma y encourage further studies in patients with long-term dialysis after renal transplantation.