Indications, results, and complications of tacrolimus conversion in pediatric renal transplantation

It is the practice of many pediatric renal transplant programs to 'convert' children taking cyclosporin A (CsA) to tacrolimus, although the indication s for, Outcome, and complications of this practice remain obscure. To bette r understand these aspects of tacrolimus 'conversion' a, fax survey was sen t to 119 North American pediatric renal transplant centers. Analyzable resp onses were received from 52 centers (44%), and included data from approxima te to 1,815 pediatric renal transplants performed between 1991 and 98. Stro ng indications for tacrolimus conversion were: antibody-resistant rejection , CsA-resistant rejection, and CsA intolerance (strong indication in 72%, 6 5%, and 52%, of centers, respectively). Steroid-resistant rejection and cos metic side-effects were considered strong indications less often. Initial a nti-rejection therapy Was usually increased corticosteroid dose (47/52 cent ers). Antibody therapy was most commonly used for steroid-resistant rejecti on (44 centers). For steroid- and antibody-resistant rejection, tacrolimus conversion was most common (33 centers). Tacrolimus conversion for antibody -resistant rejection led to improvement of serum creatinine (SCr) in 27% of patients, stabilization of SCr in 46%, worsening of SCr in 11%, and graft loss in 16%. Reported complications after tacrolimus conversion included hy perglycemia, hyperkalemia. lymphoproliferative disorder. infection, and neu rologic problems. We conclude that the major indication for tacrolimus conv ersion in pediatric transplant programs appears to be rejection. Outcome af ter tacrolimus conversion appears good. With the majority of patients exper iencing stable or improved allograft function. These data provide direction for further Study, including timing of tacrolimus conversion and interacti on with other therapies.