2011 - ISBTS 2011 Symposium


Oral Communications 4: Intestinal Immunosuppression / Rejection

6.134 - Comparison between oral and intravenous induction with tacrolimus in intestinal transplantation patients

Presenter: Khalid, Sharif, Birmingham, United Kingdom
Authors: Ahmed Taha1, Girish Gupte1, Basem Khalil1, Darius Mirza1, Khalid Sharif1


134
Comparison between oral and intravenous induction with tacrolimus in intestinal transplantation patients

Ahmed Taha, Girish Gupte, Basem Khalil, Darius Mirza, Khalid Sharif

Liver Unit (including small bowel transplantation), Birmingham Children Hospital, Birmingham, United Kingdom

Background/Aim: Achieving optimal tacrolimus level (TL), either by oral (O-T) or IV route (IV-T), early post intestinal transplantation (ITx) is ideal. Aim is to report on a single centre experience with IV-T.

Patients and Methods: Records of two groups were retrieved from a prospectively maintained database. Group-1 was started on O-T dose of 0.075 mg/kg/dose, this was changed to IV-T 24-hour-infusion of 0.15 mg/kg/day if low levels persist. Group-2 was started on IV-T 24-hour-infusion of 0.05 mg/kg/day. Target TL’s (measured once daily) for both groups were aimed at 15-20 ng/ml in the 1st 3 weeks then 12-15 ng/ml till third month. Values are 1st-30-days medians (range).

Results:

 

Group-1 (n=10)

Group-2 (n=11)

Age, months

24 (12-54)

40 (15.7-169.4)

Gender (male/female)

4/6

8/3

Days of IV-T

18 (1-26)

16.3 (4-30)

Median TL of each patient’s 1st-30-days-mean

18.1 ng/ml

18.5 ng/ml

Rejection episodes while on IV-T

3 (mild to moderate)

2 (severe)

Post-transplant lympho-proliferative disease (PTLD) episodes (1st 6 months)

0

5

TL’s were higher than target range 47% of days while on IV-T and were lower than target 42% of days while on O-T, despite frequent dose modification (3times/5days for IV-T and every other day for O-T) and 4 rejections episodes occurred while TL’s were within target. 9/10 patients in Group-1 were switched to IV-T on the 5th day (3-29). Group-2 patients were converted from IV-T to O-T within 5 days (0-14). Higher incidence of PTLD and opportunistic infections in children receiving IV-T at induction.

Conclusion: IV-T usage should be avoided in post-ITx population as more information is needed about pharmacokinetics and leads to higher incidence of complications (breakthrough episodes of rejection and opportunistic infections).


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