Oral absorption of tacrolimus in children with intestinal failure due to short or absent small bowel

We describe two children with intestinal failure due to short or absent sma ll bowel who underwent isolated liver transplantation for liver disease rel ated to parenteral nutrition. Both received reduced-size liver grafts whils t awaiting a suitable small bowel donor. Immunosuppressive therapy was base d on oral tacrolimus and intravenous steroids. Therapeutic levels of tacrol imus were achieved at low dosage of 0.14-0.28 mg/kg per day. Median and mea n blood tacrolimus levels were 9.9 and 13.7 ng/ml (range 4.9-42.3 ng/ml) in case 1 and 5.8 and 7.2 ng/ml (range 1-30 ng/ml) in case 2 before small bow el transplantation, respectively. Following small bowel transplantation, le vels were 17.1 and 20.1 ng/ml (range 9.2-30 ng/ml), with oral doses of 0.54 -1.35 mg/kg per day. Both children died of adenovirus pneumonia, with funct ioning grafts. Our experience demonstrates that effective levels of immunos uppression can be achieved by oral administration of tacrolimus in children with short or absent small bowel.