Tacrolimus monotherapy in adult cardiac transplant recipients: Intermediate-term results

Background: Tacrolimus (FK506) is a macrolide antibiotic that inhibits T-ce ll activation and proliferation. To date, all published trials have used ta crolimus and steroids in combination with either azathioprine or mycophenol ate mofetil, Previous experience with pediatric cardiac transplant patients at our institution suggested that use of tacrolimus alone provides an adeq uate level of immunosuppression and that withdrawal of steroids is readily achieved in most recipients. Methods: Between January 1, 1996, and July 7, 1999, we performed 77 adult c ardiac transplants. Forty-three of these patients received tacrolimus and p rednisone as primary immunosuppression, without azathioprine or mycophenola te mofetil. Thirty-two of the 43 patients started on tacrolimus have been w eaned off steroids and are maintained on monotherapy. These latter patients form the basis of this report. Results: The mean time for achieving monotherapy was 246 +/- 127 days (rang e, 106 to 730). Grade greater than or equal to 2 rejection occurred at 0.40 episodes per patient in the first 90 days (a combination of Grades 2 and 3 A/3B rejections). The freedom from treated rejection (includes all 3A/3B an d Grade 2 rejection in the first 90 days) was 69% at 90 days and 52% at 1 y ear. One patient (of 32) had documented cytomegalovirus infection (gastriti s) diagnosed at 8 months post-transplant. We observed 1 case of transplant vasculopathy and 1 case of post-transplant lymphoproliferative disorder dur ing the follow-up period. Conclusions: Our results show that use of tacrolimus alone after steroid we aning provides effective immunosuppression with low incidence of rejection, cytomegalovirus infection, transplant arteriopathy, or post-transplant lym phoproliferative disease.