Korean J Nephrol.  2002 Jul;21(4):667-674.

Tacrolimus in Delayed Graft Function in Cadaveric Renal Transplantation

• Lee MS
• Chang JW
• Han DJ
• Yu ES
• Yang WS
• Park SK

Abstract

BACKGROUND: In the presence of anticipated or established acute tubular necrosis (ATN) immediately after cadaveric kidney transplantation, induction with monoclonal or polyclonal antibody is recommended in preparation of increased risk of acute rejection caused by ATN. Tacrolimus is a potent immunosuppressive agent than cyclosporine. In this study, we analyzed retrospectively the clinical outcome of patients who had taken tacrolimus as a replacement of cyclosporine in the period of delayed graft function(DGF) to determine the eligibility of tacrolimus instead of antilymphocyte antibody in this situation.
METHODS
Between March 1, 1991 and August 31, 2000, DGF developed in eighteen first cadaveric renal transplant recipients in our center. During DGF period, twelve patients received tacrolimus based immunosuppression without OKT3. We reviewed the complete clinical course of the 12 patients.
RESULTS
Among the 12 patients, 1 patient underwent graft nephrectomy at postoperative 27 days, because of poor renal function and concomitant aspergillosis infection. In the remaining 11 patients, however, for whom tacrolimus was maintained continuously without OKT3 therapy, renal function was recovered successfully. One acute rejection developed at postoperative 15 months. One patient died at postoperative 5 months with functioning graft. One-year graft survival rate was 83%.
CONCLUSION
Tacrolimus could be used in replacement of cyclosporine for the prevention of acute rejection in DGF. This could provide a graft survival comparable to that by the monoclonal or polyclonal antibodies without the potential risk of life- threatening side effects in this situation.

Keyword

Tacrolimus; Acute tubular necrosis; Delayed graft function; Cadaveric renal transplantation; Nephrotoxicity

MeSH Terms

Antibodies
Antilymphocyte Serum
Aspergillosis
Cadaver*
Cyclosporine
Delayed Graft Function*
Graft Survival
Humans
Immunosuppression
Kidney Transplantation*
Muromonab-CD3
Necrosis
Nephrectomy
Retrospective Studies
Tacrolimus*
Transplantation
Transplants
Antibodies
Antilymphocyte Serum
Cyclosporine
Muromonab-CD3
Tacrolimus