Renal hemodynamic effect of tacrolimus in renal transplanted children

Like cyclosporine (CsA), tacrolimus acts through the inhibition of renal ph osphatase calcineurin. CsA induces reversible vasoconstriction, causing a t ransient reduction of renal plasma flow in patients with renal transplantat ion. The aim of this study was to determine the effect of tacrolimus on ren al plasma flow in renal transplanted children. Eight children were studied with a medi an age of 10.6 years, a mean glomerular filtration rate (inulin clearance) of 55 ml/min per 1.73 m(2) (range 29-95), and a mean follow-up after transplantation of 5.6 months. Effective renal plasma flow (ERPF) was studied in each patient for 12 h after tacrolimus administration. Clearanc es were obtained every 2 h for 12 h after drug administration. Tacrolimus p harmacokinetics was also studied. Average ERPF at the start of the test was 289 ml/min per 1.73 m(2) (range 177-404, SD+/-106). Variation in each of t he 2-h periods was not significant, although a mild reduction of plasma flo w was observed in three of the eight children. No correlation was found bet ween tacrolimus AUC, peak, or trough levels and renal blood flow variations . Despite the relatively small number of patients studied, these data sugge st that, in vivo, a therapeutic oral dose of tacrolimus is not necessarily followed by a significant reduction of ERPF in renal transplanted children.