Reversal of early acute rejection with increased doses of tacrolimus in liver transplantation: a pilot study.
BACKGROUND
In this pilot study, we present the results of treatment of early (3 months after liver transplantation) acute rejection episodes by increasing only the tacrolimus doses.


METHODS
Ten patients who received tacrolimus as primary treatment experienced acute mild (one case), moderate (four cases), or severe (five cases) rejection episodes. Tacrolimus dosing was increased 1-2 mg every 1 or 2 days until hepatic enzymes started to improve. Steroid basic daily doses were kept unchanged.


RESULTS
With the daily dose of tacrolimus increased by a median 1.89-fold (range: 1.2-5), alanine aminotransferase, bilirubin, and gamma-glutamyltranspeptidase levels rapidly reached normal values within the first month. During a median follow-up time of 19.5 months (range: 14-24), none of the 10 patients died or lost their graft. Control liver biopsies were done 13.5 months (range: 7-19) after rejection episode in all patients, and none demonstrated evidence of rejection or sequela.


CONCLUSIONS
This pilot study suggests that increasing tacrolimus dosage could be considered as treatment against early acute rejection episodes including the severe grade.
Boillot
O
O
Liver Transplant Unit, Edouard Herriot Hospital, Lyon, France. boillot@cismsun.univ-lyon1.fr
Viale
J P
JP
Gratadour
P
P
Meeus
P
P
Souraty
P
P
Le Derf
Y
Y
Mechet
I
I
Scoazec
J Y
JY
Berger
F
F
Paliard
P
P
D000208:Acute Disease; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D004305:Dose-Response Relationship, Drug; D006084:Graft Rejection / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation / Q000276:immunology*; D010865:Pilot Projects; D016559:Tacrolimus / Q000008:administration & dosage*; D005723:gamma-Glutamyltransferase / Q000097:blood
D007166:Immunosuppressive Agents; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D001663:Bilirubin; D016559:Tacrolimus