REVERSAL OF EARLY ACUTE REJECTION WITH INCREASED DOSES OF TACROLIMUS IN LIVER-TRANSPLANTATION - A PILOT-STUDY

Background. In this pilot study, we present the results of treatment o f early (3 months after liver transplantation) acute rejection episode s by increasing only the tacrolimus doses. Methods. Ten patients who r eceived tacrolimus as primary treatment experienced acute mild (one ca se), moderate (four cases), or severe (five cases) rejection episodes. Tacrolimus dosing was increased 1-2 mg every 1 or 2 days until hepati c enzymes started to improve. Steroid basic daily doses were kept unch anged. Results. With the daily dose of tacrolimus increased by a media n 1.89-fold (range: 1.2-5), alanine aminotransferase, bilirubin, and g amma-glutamyltranspeptidase levels rapidly reached normal values withi n the first month. During a median follow-up time of 19.5 months (rang e: 14-24), none of the 10 patients died or lost their graft. Control l iver biopsies were done 13.5 months (range: 7-19) after rejection epis ode in all patients, and none demonstrated evidence of rejection or se quela. Conclusion. This pilot study suggests that increasing tacrolimu s dosage could be considered as treatment against early acute rejectio n episodes including the severe grade.