TACROLIMUS (FK506) IN ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR SEVERE APLASTIC-ANEMIA FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION

Severe aplastic anemia (SAA) is a frequent complication of orthotopic liver transplantation for non-typeable viral hepatitis, Allogeneic bon e marrow transplantation (BMT) may successfully reconstitute hematopoi esis but the optimal conditioning regimen and graft-versus-host diseas e (GVHD) prophylaxis in such patients are unknown, Allogeneic BMT was undertaken in an 8-year-old male patient who developed SAA 6 weeks aft er cadaveric orthotopic liver transplantation for fulminant hepatic fa ilure secondary to presumed non-typeable viral hepatitis, The preparat ive regimen for his HLA genotypically identical sibling BMT consisted of cytoxan and anti-thymocyte globulin, Tacrolimus (FK506) and prednis one, used to prevent liver graft rejection, were supplemented with met hotrexate on post-BMT days, 1, 3, 6 and 11 for GVHD prophylaxis, Engra ftment proceeded promptly and without complications, Transfusion depen dence resolved 6 weeks after BMT. The patient is alive and well 1 year after his BMT on FK506 and prednisone without any signs of GVHD or li ver allograft rejection, This case is the first demonstration of the f easibility of continuing FK506 used for prevention of liver graft reje ction as GVHD prophylaxis for allogeneic BMT.