Suggested guidelines for the use of tacrolimus in pancreas/kidney transplantation.
As experience with tacrolimus (FK506, Prograf) accumulates and reduced rejection rates are increasingly demonstrated, some transplant centers are adopting tacrolimus-based primary immunosuppressive regimens for their patients undergoing pancreas/kidney transplantation. The guidelines provided in this article based on the experience of four major US transplant centers, cover issues related to dosing, blood levels, concomitant use of mycophenolate mofetil (MMF), antifungal and antiviral prophylaxis, and drug interactions. For post-transplant immunosuppression some centers initiate oral tacrolimus administration on postoperative day 1, 2, or 3, while others wait until day 6 or 7, when renal or gastrointestinal function has resumed. Most centers endeavor to achieve higher target trough levels (approximately 10-20 ng/mL, but not higher) in the first 3 months post-transplant, reducing levels thereafter. Several centers are now using MMF instead of azathioprine as an adjunct to tacrolimus. Conversion from cyclosporine to tacrolimus during maintenance therapy is often considered in the event of rejection or when adverse events do not respond to dosage reduction.
Gruessner
R W
RW
Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
Bartlett
S T
ST
Burke
G W
GW
Stock
P G
PG
D000284:Administration, Oral; D000935:Antifungal Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D015725:Fluconazole / Q000008:administration & dosage; D006084:Graft Rejection / Q000517:prevention & control*; D017408:Guidelines as Topic; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016030:Kidney Transplantation; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D009181:Mycoses / Q000517:prevention & control; D016035:Pancreas Transplantation; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D014481:United States; D014777:Virus Diseases / Q000517:prevention & control
D000935:Antifungal Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D015725:Fluconazole; D009173:Mycophenolic Acid; D016559:Tacrolimus