SUGGESTED GUIDELINES FOR THE USE OF TACROLIMUS IN PANCREAS KIDNEY TRANSPLANTATION/

As experience with tacrolimus (FK506, Prograf(R)) accumulates and redu ced rejection rates are increasingly demonstrated, some transplant cen ters are adopting tacrolimus-based primary immunosuppressive regimens for their patients undergoing pancreas/kidney transplantation. The gui delines provided in this article based on the experience of four major US transplant centers, cover issues related to dosing, blood levels, concomitant use of mycophenolate mofetil (MMF), antifungal and antivir al prophylaxis, and drug interactions, For post-transplant immunosuppr ession some centers initiate oral tacrolimus administration on postope rative day 1, 2, or 3, while others wait until day 6 or 7, when renal or gastrointestinal function has resumed. Most centers endeavor to ach ieve higher target trough levels (similar to 10-20 ngl/mL, but not hig her) in the first 3 months post-transplant, reducing levels thereafter . Several centers are now using MMF instead of azathioprine as an adju nct to tacrolimus. Conversion from cyclosporine to tacrolimus during m aintenance therapy is often considered in the event of rejection or wh en adverse events do not respond to dosage reduction.