STEROID WITHDRAWAL IN TACROLIMUS (FK506)-TREATED PEDIATRIC LIVER-TRANSPLANT RECIPIENTS

Purpose: The use of steroids in pediatric transplant recipients is ass ociated with significant adverse side effects. The authors examined th e feasibility of steroid withdrawal in patients who underwent immunosu ppression with tacrolimus (FK506; FK). Methods: All pediatric liver tr ansplant recipients on FK greater than 6 months were evaluated for ste roid withdrawal. FK was administered 0.3 mg/kg/d in two divided doses. Steroids were tapered as tolerated with goals of 0.2 to 0.3 mg/kg/d a t 6 weeks, 0.2 to 0.3 mg/kg every other day at 3 months, and complete withdrawal after 6 months. Steroid bolus and taper were instituted for enzyme elevation or rejection during biopsy. Results: Twenty-nine pat ients underwent evaluation for steroid withdrawal. Five patients could not be placed on FK506 monotherapy (chronic, recurrent rejection or L PD). The remaining 24 had steroids withdrawn. Twelve (50%) had no sequ elae and continue on FK monotherapy (mean, 22 months off steroids). Th e other 12 required intermittent steroid therapy for presumed or biops y-proven rejection (n = 7), graft dysfunction (FK toxicity, n = 2), ly mphoproliferative disease necessitating reduction in FK (n = 2) or exa cerbations of asthma (n = 1). Five of these 12 patients are now on FK monotherapy (mean, 6 months) for a total of 17 of the 24 (71%) current ly off steroids. Conclusion: FK monotherapy can be successfully used t o withdraw steroid therapy in the majority of pediatric liver transpla nt recipients with few sequelae. Copyright (C) 1997 by W.B. Saunders C ompany.