  
Tacrolimus plus mycophenolate mofetil effective for second transplants
Last Updated: 2001-04-19 15:30:20 EDT (Reuters Health)
By Michelle Chard
WESTPORT, CT (Reuters Health) - Low-dose tacrolimus administered intravenously (TAC i.v.) combined with oral TAC, mycophenolate mofetil (MMF) and steroids provide effective immunosuppression in recipients of simultaneous pancreas-kidney transplants who have undergone previous transplants, according to researchers.
Dr. Gaetano Ciancio and colleagues from the University of Miami School of Medicine note that clinical trials have shown that quadruple immunosuppression that includes the combination of TAC and MMF reduces the incidence of acute rejection episodes in simultaneous pancreas-kidney transplantation. In the current study, the investigators sought to decrease the morbidity associated with antibody therapy without increasing acute rejection rates.
In the April issue of Clinical Transplantation, the investigators report their experience with 10 patients undergoing second transplants who were treated without antibody induction.
The researchers explain that induction immunosuppression consisted of a continuous infusion of TAC at a dose of 1 mg/24 hr started immediately after surgery and continued for a mean of 6 days. The dose was adjusted with an oral dose of TAC to maintain a trough level of 10 to 15 ng/mL during the first 3 weeks. Methylprednisolone 750 mg was given on the day of surgery and was tapered to 0.1 mg/kg per day over 3 months and 1 g of MMF was given orally twice a day.
The authors report that two patients experienced episodes of acute rejection that responded to steroid treatment. After a mean followup of 20.4 months, the kidney and pancreas are functioning in all patients.
"This is a new induction treatment for patients with previous transplants, sparing them of antibody induction therapy," Dr. Ciancio commented to Reuters Health. "Basically you can perform a transplant in a patient with a previous failed transplant with less immunosuppression without increasing the risk of rejection."
Clin Transplantation 2001;15:142-145.
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