title: The impact of tacrolimus as rescue therapy in children using a double immunosuppressive regimen after heart transplantation.
abstract: BACKGROUND
  Organ transplant recipients with refractory rejection or intolerance to the prescribed immunosuppressant may respond to rescue therapy with tacrolimus. We sought to evaluate the clinical outcomes of children undergoing heart transplantation who required conversion from a cyclosporine-based, steroid-free therapy to a tacrolimus-based regimen.
  
  
  METHODS
  We performed a prospective, observational, cohort study of 28 children who underwent conversion from cyclosporine-based, steroid-free therapy to a tacrolimus-based therapy for refractory or late rejection or intolerance to cyclosporine.
  
  
  RESULTS
  There was complete resolution of refractory rejection episodes and adverse side effects in all patients. The incidence rate (×100) of rejection episodes before and after conversion was 7.98 and 2.11, respectively (P ≤ .0001). There was a 25% mortality rate in patients using tacrolimus after a mean period of 60 months after conversion.
  
  
  CONCLUSIONS
  Tacrolimus is effective as rescue therapy for refractory rejection and is a therapeutic option for pediatric patients.
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: K C
authors.initials: KC
authors.lastname: Branco
authors.forename: E
authors.initials: E
authors.lastname: Azeka
authors.forename: E
authors.initials: E
authors.lastname: Trindade
authors.forename: F R B
authors.initials: FR
authors.lastname: Galas
authors.forename: L A
authors.initials: LA
authors.lastname: Hajjar
authors.forename: L
authors.initials: L
authors.lastname: Benvenuti
authors.forename: A
authors.initials: A
authors.lastname: Riso
authors.forename: C
authors.initials: C
authors.lastname: Tanamati
authors.forename: J
authors.initials: J
authors.lastname: Penha
authors.forename: J O C
authors.initials: JO
authors.lastname: Auler
authors.forename: M
authors.initials: M
authors.lastname: Jatene
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D011446:Prospective Studies; D016879:Salvage Therapy; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus