Summary
Abstract
Tacrolimus (FK-506) is an immunosuppressant agent that acts by a variety of different mechanisms which include inhibition of calcineurin. It is used as a therapeutic alternative to cyclosporin, and therefore represents a cornerstone of immunosuppressive therapy in organ transplant recipients. Tacrolimus is now well established for primary immunosuppression in liver and kidney transplantation, and experience with its use in other types of solid organ transplantation, including heart, lung, pancreas and intestinal, as well as its use for the prevention of graft-versus-host disease in allogeneic bone marrow transplantation (BMT), is rapidly accumulating.
Large randomised nonblind multicentre studies conducted in the US and Europe in both liver and kidney transplantation showed similar patient and graft survival rates between treatment groups (although rates were numerically higher with tacrolimus-versus cyclosporin-based immunosuppression in adults with liver transplants), and a consistent statistically significant advantage for tacrolimus with respect to acute rejection rate. Chronic rejection rates were also significantly lower with tacrolimus in a large randomised liver transplantation trial, and a trend towards a lower rate of chronic rejection was noted with tacrolimus in a large multicentre renal transplantation study.
In general, a similar trend in overall efficacy has been demonstrated in a number of additional clinical trials comparing tacrolimus-with cyclosporin-based immunosuppression in various types of transplantation. One notable exception is in BMT, where a large randomised trial showed significantly better 2-year patient survival with cyclosporin over tacrolimus, which was primarily attributed to patients with advanced haematological malignancies at the time of (matched sibling donor) BMT. These survival results in BMT require further elucidation. Tacrolimus has also demonstrated efficacy in various types of transplantation as rescue therapy in patients who experience persistent acute rejection (or significant adverse effects) with cyclosporin-based therapy, whereas cyclosporin has not demonstrated a similar capacity to reverse refractory acute rejection. A corticosteroid-sparing effect has been demonstrated in several studies with tacrolimus, which may be a particularly useful consideration in children receiving transplants.
The differences in the tolerability profiles of tacrolimus and cyclosporin may well be an influential factor in selecting the optimal treatment for patients undergoing organ transplantation. Although both drugs have a similar degree of nephrotoxicity, cyclosporin has a higher incidence of significant hypertension, hypercholesterolaemia, hirsutism and gingival hyperplasia, while tacrolimus has a higher incidence of diabetes mellitus, some types of neurotoxicity (e.g. tremor, paraesthesia), diarrhoea and alopecia.
Conclusion: Tacrolimus is an important therapeutic option for the optimal individualisation of immunosuppressive therapy in transplant recipients.
Pharmacodynamic Properties
Tacrolimus (FK-506) is a macrolide immunosuppressant that acts by a variety of different mechanisms which include inhibition of calcineurin. The drug inhibits T lymphocyte activation and transcription of cytokine genes including that for interleukin-2. Tacrolimus inhibits cell-mediated and, to a lesser extent, humoral immune responses. Cytokines produced by T helper (Th)1 cells are preferentially suppressed over those produced by Th2 cells.
The mechanism of action of tacrolimus is largely similar to that of cyclosporin, but tacrolimus is 10 to 100 times more potent. The drugs both inhibit calcineurin but do so via formation of complexes with different immunophilins: tacrolimus binds to FK-506 binding protein 12, whereas cyclosporin binds to cyclophilin A. The drugs appear to differ in their effects on patterns of Th2 cell cytokine expression and possibly some aspects of humoral immunity. Furthermore, lymphocyte sensitivity to the drugs may differ between patients.
In animal models, tacrolimus had an organ-specific effect in stimulating hepatic regeneration after partial hepatectomy, and attenuated hepatic ischaemic or reperfusion injury. Tacrolimus does not appear to cause postoperative cholestasis in liver transplant recipients, and postoperative disturbances in biliary secretion and flow rates may recover more rapidly with tacrolimus than cyclosporin.
Like cyclosporin, tacrolimus has nephrotoxic effects that appear to be mechanistically related to its immunosuppressive activity, possibly involving inhibition of calcineurin. Tacrolimus suppresses insulin production at the trans-criptional level and appears to be more diabetogenic than cyclosporin in some patients. In patients with liver transplants, tacrolimus reduced β cell secretory reserve, and was associated with significant insulin resistance and impaired β cell-α cell axis.
Further clarification is required of the comparative effects of tacrolimus and cyclosporin on factors involved in cardiac transplant-associated coronary artery disease. Although tacrolimus has been associated with a lower incidence of positivity for anti-endothelial cell antibodies than cyclosporin, a higher incidence of pathological microvascular endothelial dysfunction has also been reported. Tacrolimus may have an in vitro antithrombotic effect. Findings have been conflicting regarding the comparative effect of tacrolimus and cyclosporin on endothelium-independent microcirculatory responses 1 year after cardiac transplantation. Tacrolimus and cyclosporin appear to have similar effects on most aspects of cardiac function in renal or liver transplant recipients.
Pharmacokinetic Propertie
Like cyclosporin, the pharmacokinetic properties of tacrolimus can vary widely between individuals and dosage regimens are titrated according to whole-blood trough drug concentrations. Oral bioavailability of tacrolimus is about 20 to 25%, and food appears to have a significant effect in reducing the rate and extent of absorption. The drug binds extensively to erythrocytes, and whole-blood concentrations of tacrolimus are approximately 15 to 35 times those measured in plasma. Tacrolimus is almost completely metabolised prior to elimination. Metabolism is via 3A4 isoenzymes of the cytochrome P450 (CYP) system, primarily in the liver but also in the intestinal mucosa, and a number of metabolites are formed. At least 1 metabolite appears to be active, although the immunosuppressive activity of tacrolimus is primarily due to the parent drug. Elimination half-life of tacrolimus has been reported to be approximately 12 hours in liver transplant recipients and 19 hours in renal transplant recipients. Less than 1% of an intravenous dose of tacrolimus is eliminated unchanged in the urine. The main route of elimination for tacrolimus and its metabolites is via the biliary tract. Like cyclosporin, tacrolimus is subject to a number of pharmacokinetic (and pharmacodynamic) drug interactions of potential clinical significance, including those involving other drugs metabolised by the CYP enzyme system.
Therapeutic Efficacy
In most clinical trials, tacrolimus-based primary immunosuppression initially included concomitant administration of corticosteroids, typically with azathioprine or mycophenolate mofetil, and sometimes with adjunctive antilymphocyte antibody induction therapy. In general, rescue therapy with tacrolimus usually involved simple conversion from cyclosporin to tacrolimus without modification of concomitant drug therapy. Clinical trials comparing tacrolimus-with cyclo-sporin-based immunosuppression were conducted in a nonblind fashion, presumably because of the need to monitor whole-blood trough drug concentrations to optimise the clinical management of patients. In the following sections, cyclosporin refers to the standard formulation of the drug (the microemulsion formulation is specified when applicable).
Hepatic Transplantation
As primary immunosuppression in adults with hepatic transplantation, tacrolimus-based regimens achieved similar patient and graft survival rates to cyclosporin-based regimens, with a trend towards higher rates with tacrolimus, and significantly lower rates of acute rejection. This was demonstrated in 2 large multicentre randomised trials, one of which also showed significantly lower rates of chronic rejection at 1 and 3 years post-transplantation among patients receiving tacrolimus-based immunosuppression.
In general, similar overall efficacy trends were noted in more recent smaller randomised studies comparing tacrolimus with the cyclosporin microemulsion formulation. Results of these studies showed patient and graft survival rates of approximately 75 to 100% and 70 to 95%, respectively, after 6 to 30 months of tacrolimus-based therapy; acute rejection rates varied widely between studies. Long term survival data from a large cohort of 1000 patients treated with tacrolimus-based immunosuppression after liver transplantation indicate 6-year patient and graft survival rates of 68 and 63%, respectively. Several studies demonstrated that corticosteroid therapy could be successfully withdrawn in approximately 70 to 90% of liver transplant recipients treated with tacrolimus-based immunosuppressive therapy.
Tacrolimus is also effective as rescue therapy in adult patients with persistent acute or chronic rejection or drug-related toxicity with cyclosporin-based primary immunosuppression after hepatic transplantation. This has been demonstrated in a number of noncomparative studies, the largest involving a group of 475 patients with 2-year patient and graft survival rates of 80 and 73%, respectively, after conversion from cyclosporin to tacrolimus because of acute or chronic rejection.
In general, results of studies with tacrolimus-based primary immunosuppressive and rescue therapy for paediatric liver transplantation have been very similar to those of studies in adult patients. Results of the only prospective randomised comparison between tacrolimus (n = 30; mean age 3.5 years) and cyclosporin (n = 21; mean age 3.2 years) as primary immunosuppression showed similar 1-year patient (80 vs 81%) and graft (70 vs 71%) survival rates, and a trend favouring tacrolimus for acute rejection rate (52 vs 79%). Importantly, some studies demonstrated that corticosteroid therapy can be successfully discontinued in approximately 70 to 85% of children receiving tacrolimus as primary immunosuppressive or rescue therapy.
Renal Transplantation
Tacrolimus-based regimens achieved similar patient and graft survival rates and lower rates of acute rejection compared with cyclosporin-based regimens when used as primary immunosuppression in adults with renal transplantation. This was demonstrated in 2 large multicentre randomised trials; 1-year patient survival rates were ≈95% and corresponding graft survival rates were ≈85 to 90% for both treatment groups. A statistically significant advantage favouring tacrolimus for acute rejections rates was noted in both studies (26 vs 46% and 31 vs 46%; both p < 0.001). One of the multicentre studies (European data) showed a nonsignificant trend towards a lower rate of chronic rejection among tacrolimus recipients than cyclosporin recipients at 4 years post-transplantation (5.5 vs 11.3%). Long term (3-year) survival data from one of the trials (US data) showed similar rates of patient (≈90%) and graft (≈80%) survival for both treatment groups. In this study, approximately 25% of patients were African-American, and results in this high-risk subgroup mirrored those for all patients in each treatment group. Numerous noncomparative, retrospective or meta-analytical trials, as well as a few small-to moderate-sized randomised comparisons with cyclosporin microemulsion, have also been conducted with tacrolimus-based regimens for primary immunosuppression in adult renal transplant recipients, and results generally support those of the large multicentre studies.
Rescue therapy with tacrolimus, primarily in patients who developed acute rejection while receiving cyclosporin-based primary immunosuppression (n = 40 to 169), was associated with patient survival rates >90% and corresponding graft survival rates >70% after 1 to 3 years of follow-up after conversion. In general, results of studies with tacrolimus-based primary immunosuppressive and rescue therapy for paediatric renal transplantation have been very similar to those of studies in adult patients. In the largest study, 81 children (82 transplants) received tacrolimus-based therapy as primary immunosuppression. One-year patient and graft survival rates approached 100%, and 4-year rates were 94 and 84%, respectively. About two-thirds of patients were successfully withdrawn from corticosteroid therapy.
Heart Transplantation
In prospective studies comparing tacrolimus-with cyclosporin-based primary immunosuppressive regimens in heart transplant recipients, patient survival rates were similar between treatment groups and there was a consistent trend towards more favourable acute rejection rates with tacrolimus. One-and ≈2-year patient survival rates were ≈80 to 90% for both treatment groups, and a large non-randomised comparison also showed similar 5-year patient survival rates between tacrolimus and cyclosporin treatment groups (76 vs 71%). In a moderate-sized randomised study of 73 patients, the mean number of acute rejection episodes per patient was significantly lower among tacrolimus than cyclosporin recipients (1.33 vs 1.87; p < 0.01). A number of small studies (n < 20) of tacrolimus as rescue therapy in adults showed that at least 70% of patients had either no rejection episodes or only mild rejection after conversion from cyclosporin to tacrolimus (follow-up periods were usually at least 6 months).
Tacrolimus has had limited use in paediatric heart transplantation. Tacrolimus-based primary immunosuppression was associated with good patient survival rates in a group of 26 children (≈80% at 1 and 3 years post-transplantation). In addition, rates of moderate to severe acute rejection were lower and corticosteroid withdrawal rates were much higher than those in historical controls treated with cyclosporin-based therapy. The results of a nonrandomised study of 40 paediatric heart transplant recipients showed that the presence of 2 HLA-DR loci donor/ recipient mismatches increased the risk of high-grade rejection in children receiving cyclosporin-based therapy, whereas the risk of rejection was not increased in those receiving tacrolimus-based therapy. Tacrolimus-treated children with 2 HLA-DR mismatches had a significantly lower risk of severe rejection than cyclosporin-treated children with only 1 HLA-DR mismatch. In small studies (n < 25) of tacrolimus as rescue therapy, graft loss was not reported (follow-up periods up to 40 months) and corticosteroid dosages were reduced or discontinued in most children.
Lung Transplantation
Tacrolimus-and cyclosporin-based primary immunosuppressive regimens were associated with similar 1-(83 vs 71%) and 2-year (76 vs 66%) patient survival rates, as well as similar proportions of patients free from acute rejection (14 vs 11.5%), in a prospective randomised study of 133 lung transplant recipients. Results for all of these end-points tended to favour tacrolimus, and the trial showed a significantly lower incidence of obliterative bronchiolitis among tacrolimus than cyclosporin recipients (21.7 vs 38%; p < 0.05).
In general, the use of tacrolimus as rescue therapy in small numbers of patients with lung transplantation (n ≤15) was associated with a reduced incidence of acute rejection after conversion from cyclosporin, and at least two-thirds of patients remained alive during mean follow-up periods of approximately 6 to 18 months.
Pancreas or Kidney and Pancreas Transplantation
Numerous studies have been conducted demonstrating the efficacy of tacrolimus as primary immunosuppression after solitary pancreas transplantation or simultaneous pancreas and kidney transplantation (SPK); however, no large randomised trial has prospectively compared tacrolimus-with cyclosporin-based regimens in this clinical setting. Nevertheless, data from 2 large (n > 200) retrospective analyses indicate significantly better pancreas graft survival with tacrolimus-based therapy in patients with solitary pancreas or SPK transplantation, and patient and renal graft survival was better with tacrolimus than cyclosporin in SPK recipients. For example, a multicentre matched-pair analysis comparing tacrolimus-with cyclosporin-based therapy in SPK recipients at 18 months post-transplant showed pancreas graft survival rates of 88 versus 71%, renal graft survival rates of 94 versus 77% and patient survival rates of 97 versus 83% (p ≤0.002 for all comparisons). Results of 2 moderate-sized studies of tacrolimus as rescue therapy in SPK recipients showed patient survival rates approaching 100% and pancreas and renal graft survival rates of about 90% (follow-up period ≤1 year after conversion from cyclosporin to tacrolimus).
Intestinal Transplantation
Several reports involving small numbers of patients indicate that tacrolimus is effective in this clinical setting. Data from the International Transplant Registry (n = 170) indicate that, depending on the subgroup of intestinal transplant recipients, tacrolimus-based primary immunosuppression is associated with 1-and 3-year patient survival rates of 59 to 83% and 40 to 47%, respectively, and 1-and 3-year graft survival rates of 51 to 65% and 29 to 38%, respectively. In general, patient and graft survival rates were as good as or better than those achieved with cyclosporin-based regimens. Among cyclosporin recipients, 1-and 3-year patient survival rates were 41 to 57% and 28 to 50%, respectively, and 1-and 3-year graft survival rates were 17 to 44% and 11 to 41%, respectively.
Bone Marrow Transplantation
Three randomised comparative trials have consistently demonstrated a lower incidence of grade II to IV acute graft-versus-host disease (GVHD) with tacrolimus-than cyclosporin-based therapy after allogeneic bone marrow transplantation (BMT). However, the largest of the trials (n = 329) also showed that 2-year overall survival (57 vs 47%; p < 0.05) and disease-free survival (50 vs 41%; p = 0.01) were significantly better among cyclosporin-than tacrolimus-treated patients with haematological malignancy who received BMT from matched sibling donors. These differences were attributed primarily to patients with advanced haematological malignancy at the time of BMT. These survival data in BMT require confirmation. Tacrolimus has also been used with some success in the treatment of patients who developed acute or chronic GVHD or significant toxicity while receiving cyclosporin-based immunosuppressive therapy after BMT, but data are preliminary.
Tolerability
The principal adverse effects associated with tacrolimus treatment include nephrotoxicity, neurotoxicity, disturbances in glucose metabolism, gastrointestinal (GI) disturbance and hypertension. Susceptibility to infection and malignancy is also increased. All of these adverse effects also occur with cyclosporin, although the incidence of some adverse effects differs between the drugs (see later in this section). Tacrolimus is rarely associated with the cyclosporin-specific adverse effects hirsutism, gingivitis and gum hyperplasia, but it may cause alopecia and pruritus in some patients.
Many of the adverse effects of tacrolimus are dose-related; nephrotoxicity, neurotoxicity, glucose metabolism disturbances, GI disturbances and infections may occur more frequently or be more severe at higher whole-blood tacrolimus concentrations. Importantly, these adverse events can often be managed by dosage reductions. Concomitant drugs such as corticosteroids may also contribute to some adverse effects.
In the major trials in patients undergoing liver or kidney transplants, withdrawal rates because of adverse events tended to be higher with tacrolimus than cyclosporin. Nephrotoxicity occurred in as many as half of patients treated with either tacrolimus or cyclosporin. Neurotoxicity associated with tacrolimus most frequently manifests as tremor, headache, insomnia and paraesthesia, and some neurological effects (including tremor and paraesthesia) may be more problematic with tacrolimus than with cyclosporin.
Diabetes mellitus and/or hyperglycaemia also tended to occur more frequently with tacrolimus than with cyclosporin in the major trials in kidney or liver transplant recipients. In 2 large multicentre randomised kidney transplantation trials, the incidence of new-onset type 1 diabetes mellitus was 20 vs 4% in the US trial and 8 vs 2% in the European study. However, about one-quarter to one-third of affected tacrolimus recipients were able to discontinue insulin therapy within 1 year. Furthermore, tacrolimus has generally not been more diabetogenic than cyclosporin in cardiac transplant trials. Also, at least 1 recent study in renal transplant recipients showed a lower incidence of post-transplantation diabetes mellitus with tacrolimus than in previous reports, suggesting that, with more experience, it may be possible to reduce the risk of developing this complication. Other metabolic disturbances that can occur with tacrolimus include hyper-kalaemia and hypomagnesaemia.
A number of studies have shown that tacrolimus has less adverse effect than cyclosporin on lipid profiles and/or the general cardiovascular risk profile. In particular, significantly lower serum levels of total cholesterol, triglycerides and/or low density lipoprotein-cholesterol have been reported with tacrolimus. Hypertension occurred in up to half of patients treated with tacrolimus in major trials, but it was normally mild to moderate in severity, whereas hypertension can be more severe with cyclosporin. In cardiac transplant recipients, hypertension requiring treatment occurred more frequently with cyclosporin-than tacrolimus-based regimens.
GI disturbance, including diarrhoea, nausea and constipation, occurs commonly in patients treated with tacrolimus; diarrhoea is more frequent with tacrolimus than with cyclosporin.
Infection rates were similar in tacrolimus-and cyclosporin-treated groups in the major clinical trials in kidney or liver transplant recipients.
The tolerability profile of tacrolimus in children is generally similar to that in adults. However, children are at increased risk of potentially fatal Epstein-Barr virus-related post-transplant lymphoproliferative disorders (PTLD). The inci-dence of PTLD in paediatric liver transplant recipients may be higher with tacrolimus-than cyclosporin-based immunosuppression. From the reported ex-periences (in >10 patients) of using tacrolimus in primary liver transplantation in children, the incidence of PTLD usually ranged from 3 to 11%, although higher values have been reported. The incidence of PTLD in paediatric patients converted to tacrolimus therapy appears to be higher than that in primary therapy, but this may be associated with high cumulative dosages of immunosuppressive agents required to treat intractable rejection.
The risks of tacrolimus treatment during pregnancy appear to be no greater than those with cyclosporin, and it has been suggested that tacrolimus may be associated with a lower incidence of maternal hypertension or pre-eclampsia.
Dosage and Administration
The dosage recommendations outlined in this section focus on the use of tacrolimus in the US and UK in patients who have undergone liver or kidney transplantation. Although treatment regimens can vary between countries and individual transplantation centres, it is likely that tacrolimus is used in a similar manner for immunosuppression following other types of transplantation.
Whenever possible, tacrolimus should be initiated using the oral route of administration. For patients unable to take tacrolimus orally, therapy may be initiated by continuous intravenous infusion. In the US, the recommended intravenous starting dose is 0.03 to 0.05 mg/kg/day for adults receiving liver or kidney transplantation and for children receiving liver transplantation; no specific recommendation for paediatric kidney transplantation is provided in US prescribing information. In the UK, initial intravenous dose recommendations for adults are 0.01 to 0.05 mg/kg/day for liver and 0.05 to 0.10 mg/kg/day for kidney transplantation; corresponding recommendations for children are 0.05 mg/kg/day for liver and 0.1 mg/kg/day for kidney transplantation. Conversion from intravenous to oral therapy should occur as soon as is clinically feasible, usually within 2 to 3 days. Whether administered by the oral or intravenous route, the initial dose of tacrolimus should begin approximately 6 hours after the completion of liver transplant surgery and within 24 hours of kidney transplantation surgery.
Oral tacrolimus is administered in 2 divided daily doses at 12-hour intervals. In adults, the recommended starting oral dosage of tacrolimus as primary immunosuppression is 0.10 to 0.15 mg/kg/day (US) or 0.10 to 0.20 mg/kg/day (UK) for liver transplantation and 0.2 mg/kg/day (US) or 0.15 to 0.30 mg/kg/day (UK) for kidney transplantation. Initial recommended dosage in children receiving liver transplantation is 0.15 to 0.20 mg/kg/day (US) or 0.3 mg/kg/day (UK). In the UK, 0.3 mg/kg/day is the recommended initial dose of tacrolimus in paediatric renal transplant recipients; US prescribing information does not provide a corresponding recommendation for this patient population.
During maintenance therapy the dose of tacrolimus can often be reduced. In general, children require higher doses than adults to achieve similar blood concentrations of tacrolimus. Likewise, African-American patients typically require higher tacrolimus doses than Caucasian patients (at least in kidney transplantation) to achieve similar blood concentrations of the drug. Patients with hepatic or renal dysfunction should receive doses at the lowest value of the recommended intravenous and oral dosage ranges (and further dosage reductions may be required).
When tacrolimus is used as rescue therapy in patients not responding to (or not tolerating) cyclosporin-based therapy, treatment should begin with the same initial dosage as for primary therapy in that particular allograft (UK recommendation). Tacrolimus should not be started until approximately 24 hours after discontinuation of cyclosporin therapy.
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References
Current Regulatory Status on Prograf (tacrolimus). Osaka: Fujisawa Pharmaceutical Co. Ltd. Jul 1999. (Data on file)
Spencer CM, Goa KL, Gillis JC. Tacrolimus: an update of its pharmacology and clinical efficacy in the management of organ transplantation. Drugs 1997 Dec; 54: 925–75
Peters DH, Fitton A, Plosker GL, et al. Tacrolimus: a review of its pharmacology, and therapeutic potential in hepatic and renal transplantation. Drugs 1993 Oct; 46: 746–94
Lang P, Baron C. Molecular mechanisms of immunosuppressive chemical agents recently introduced in clinical transplantation protocols. Nephrol Dial Transplant 1997 Oct; 12: 2050–4
Thomson AW, Bonham CA, Zeevi A. Mode of action of tacrolimus (FK506): molecular and cellular mechanisms. Ther Drug Monit 1995 Dec; 17: 584–91
Khanna A, Cairns V, Hosenpud. Tacrolimus induces increased expression of transforming growth factor-β1 in mammalian lymphoid as well as nonlymphoid cells. Transplantation 1999; 67: 614–9
Jiang H, Kobayashi M. Differences between cyclosporin A and tacrolimus in organ transplantation. Transplant Proc 1999 Aug;31: 1978–80
Weimer R, Melk A, Daniel V, et al. Switch from cyclosporine A to tacrolimus in renal transplant recipients: impact on the TH1, TH2 and monokine responses [abstract]. Nephrol Dial Transplant 1998 Jun; 13: A257
Zipperle S, Weimer R, Golling M, et al. Impaired T-cell IL-10 secretion and CD4 helper function in liver transplant patients treated with tacrolimus. Transplant Proc 1997 Feb–Mar; 29: 1079–80
Rayes N, Bechstein WO, Volk HP, et al. Distribution of lym-phocyte subtypes in liver transplant recipients. Transplant Proc 1997 Feb-Mar; 29: 501–2
Takeuchi H, Hirano T, Oka K, et al. Lymphocyte sensitivity to cyclosporine and tacrolimus in chronic renal failure patients and clinical significance in renal transplantation. Transplant Proc 1998 Feb; 30: 36–9
Smythe E, Delaney MP, Higgins RM, et al. Sensitivity of lymphocytes from renal transplant patients to cyclosporin A (CyA) and tacrolimus (FK506) [abstract]. Nephrol Dial Transplant 1998 Jun; 13: A257
Bilzer M, Gerbes AL. Prevention of oxidative liver injury by the immunosupressant tacrolimus (FK 506) [abstract]. Hepatology 1998; 28 (4 Pt 2): 327A
Kaibori M, Sakitani K, Oda M, et al. Immunosuppressant FK506 inhibits inducible nitric oxide synthase gene expression at a step of NF-κ-B activation in rat hepatocytes. J Hepatol 1999; 30: 1138–45
Sauer P, Stiehl A, Otto G, et al. In patients with orthotopic liver transplantation, serum markers of cholestasis are unreliable indicators of biliary secretion. JHepatol 1995 May; 22: 561–4
McCashland TM, Donovan JP, Amelsberg A, et al. Bile acid metabolism and biliary secretion in patients receiving orthotopic liver transplants: differing effects of cyclosporine and FK506. Hepatology 1994 Jun; 19: 1381–9
Söderdahl G, Groth C-G, Angelin B, et al. FK506 improves recovery of bile secretion following orthotopic liver transplantation in man. Transplant Proc 1995 Feb; 27: 1125
Ericzon BG, Eusufzai S, Soderdahl G, et al. Secretion and composition of bile after human liver transplantation: studies on the effects of cyclosporine and tacrolimus [see comments]. Transplantation 1997 Jan 15; 63: 74–80
Trimarchi HM, Truong LD, Brennan S, et al. FK506-associated thrombotic microangiopathy. Transplantation 1999 Feb 27; 67: 539–44
Rostaing L, Tran-Van T, Cisterne JM, et al. Influence of early FK 506 trough levels on glomerular hemodynamics at 3 months in kidney transplant recipients. Transplant Proc 1998 Jun; 30: 1282–4
Dello Strologo L, Ardissino G, Ghio L, et al. Renal hemodynamic after tacrolimus in renal transplanted children: no evidence of a vasoconstriction effect [abstract no A3427]. J Am Soc Nephrol 1998 Sep; 9: 671A
Mor E, Yussim A, Chodoff L, et al. New immunosuppressive agents for maintenance therapy in organ transplantation: focus on adverse effects. BioDrugs 1997 Dec; 8: 469–88
Jindal RM, Sidner RA, Milgrom ML. Post-transplant diabetes mellitus: the role of immunossupression. Drug Saf 1997; 16(4): 242–57
Fernandez LA, Lehmann R, Luzi L, et al. The effect of maintenance doses of FK506 versus cyclosporin A on glucose and lipid metabolism after orthotopic liver transplantation. Transplantation 1998; 68(10): 1532–41
Varghese Z, Fernando RL, Turakhia G, et al. Oxidizability of low-density lipoproteins from Neoral and tacrolimus-treated renal transplant patients. Transplant Proc 1998 Aug; 30: 2043–6
Weis M, Wildhirt SM, Schulze C, et al. Impact of immunosup-pression on coronary endothelial function after cardiac transplantation. Transplant Proc 1998 May; 30: 871–2
Jurcevic S, Dunn MJ, Crisp S, et al. A new enzyme-linked immunosorbent assay to measure anti-endothelial antibodies after cardiac transplantation demonstrates greater inhibition of antibody formation by tacrolimus compared with cyclosporine. Transplantation 1998 May 15; 65: 1197–202
Weis M, Wildhirt SM, Schulze C, et al. Expression of vaso-active enzymes and cytokine patterns in the cardiac allograft: impact of modulation by different immunosuppressive regimens [abstract]. Eur Heart J 1998 Aug; 19 Suppl.: 306
Fuji S, Marutuka K, Sakamoto T. Tacrolimus hydrate FK-506 modulates expression of tissue factor in human monocyte/ macrophage cell line: implications for cardiac transplant atherosclerosis [abstract no. 3127]. Circulation 1997 Oct 21; 96 Suppl.: I–559
Alexis JD, Freudenberger RS, Kushwaha SS, et al. Antithrombotic effect of FK 506 versus cyclosporine in cardiac transplant recipients: potential implications in transplant arteriopathy [abstract]. J Am Coll Cardiol 1998 Feb; 31 Suppl. 2A: 207A
Rieber J, Klauss V, König A, et al. Effects of tacrolimus and cyclosporine on the coronary microcirculation after heart transplantation: a prospective study with serial intracoronary flow measurements. Transplant Proc 1998 Jun; 30: 1098–9
Therapondos G, Plevris JN, Dollinger MM, et al. Prospective randomised trial of cyclosporin (C) vs tacrolimus (T): cardiac function and heart rate variability (HRV) following liver transplantation [abstract]. Gut 1999 Apr; 44 Suppl. 1: A62
Therapondos G, Plevris JN, Dollinger MM, et al. Assessment of left ventricular wall thickness in a prospective randomised trial of cyclosporin vs tacrolimus in adult liver transplant recipients [abstract]. Hepatology 1997 Oct; 26 (Pt 2) Suppl.: 615A
Barr C, Buchalter M, Morris-Stiff G, et al. Blood pressure and left ventricular mass changes following renal transplantation in patients receiving calcineurin inhibitors [abstract]. Transplantation 1999 May 15; 67: S616
Atkison PR, Joubert GI, Guiraudon C, et al. Arteritis and increased intracellular calcium as a possible mechanism for tacrolimus-related cardiac toxicity in a pediatric transplant recipient. Transplantation 1997 Sep 15; 64: 773–5
UmashankerR, Koo C, Sato T, et al. New onset cardiomyopathy in adult liver transplant recipients on tacrolimus [abstract no. L0651]. Gastroenterology 1998 Apr 15; 114 (Pt 2) Suppl.: A1357
Sanoski CA, Vasquez EM, Bauman JL. QT interval prolongation associated with the use of tacrolimus in transplant recipients [abstract]. Pharmacotherapy 1998 Mar–Apr; 18: 427
Moffatt SD, McAlister V, Calne RY, et al. Comparative efficacy of liposomal FK506 with FK506. Transplant Proc 1998 Dec; 30: 4066–7
Moffatt SD, McAlister V, Calne RY, et al. Potential for improved therapeutic index of FK506 in liposomal formulation demonstrated in a mouse cardiac allograft model. Transplantation 1999; 67: 1205–8
Magee JC, DeBruyne LA, Bromberg JS. Divergent effects of conventional immunosuppression agents on gene therapy in transplantation [abstract]. Transplantation 1998 Jun 27; 65: S130
Venkataramanan R, Swaminathan A, Prasad T, et al. Clinical pharmacokinetics of tacrolimus. Clin Pharmacokinet 1995 Dec; 29: 404–30
Prograf (tacrolimus) prescribing information. Deerfield (IL): Fujisawa Healthcare Inc., revised Oct 1998
van-Duijnhoven E, Christiaans M, Undre N, et al. The effect of breakfast on the oral bioavailability of tacrolimus in diabetic and nondiabetic patients before transplantation. Transplant Proc 1998 Jun; 30: 1268–70
Christiaans M, van-Duijnhoven E, Beysens T, et al. Effect of breakfast on the oral bioavailability of tacrolimus and changes in pharmacokinetics at different times posttransplant in renal transplant recipients. Transplant Proc 1998 Jun; 30: 1271–3
Möller A, Iwasaki K, Kawamura A, et al. The disposition of 14C-labeled tacrolimus after intravenous and oral administration in healthy human subjects. Drug Metab Dispos 1999; 27(6): 633–6
Iwasaki K, Shiraga T, Matsuda H, et al. Further metabolism of FK506 (tacrolimus). Identification and biological activities of the metabolites oxidized at multiple sites of FK506. Drug Metab Dispos 1995; 23(1): 28–34
Alak AM, Moy S. Biological activity of tacrolimus (FK506) and its metabolites from whole blood of kidney transplant patients. Transplant Proc 1997 Aug; 29: 2487–90
Gonschior AK, Christians U, Winkler M, et al. Tacrolimus (FK506) metabolite patterns in blood from liver and kidney transplant patients. Clin Chem 1996 Sep; 42: 1426–32
Undre NA, Schäfer A, European Tacrolimus Multicentre Renal Study Group. Factors affecting the pharmacokinetics of tacrolimus in the first year after renal transplantation. Transplant Proc 1998 Jun; 30(4): 1261–3
Wallemacq PE, Furlan V, Möller A, et al. Pharmacokinetics of tacrolimus (FK506) in paediatric liver transplant recipients. Eur J Drug Metab Pharmacokinet 1998 Jul–Sep; 23: 367–70
Neylan JF, FK506 Kidney Transplant Study Group. Racial differences in renal transplantation after immunosuppression with tacrolimus versus cyclosporine. Transplantation 1998 Feb; 65: 515–23
Neylan JF, FK506 Kidney Transplant Study Group. Effect of race and immunosuppression in renal transplantation: three-year survival results from a US multicenter, randomized trial. Transplant Proc 1998 Jun; 30: 1355–8
Coukell AT, Plosker GL. Cyclosporin microemulsion (Neoral): a pharmacoeconomic review of its use compared with standard cyclosporin in renal and hepatic transplantation. Pharmacoeconomics 1998 Dec; 14: 691–708
Noble S, Markham A. Cyclosporin: a review of the pharmaco-kinetic properties, clinical efficacy and tolerability of a microemulsion-based formulation (Neoral). Drugs 1995; 50(5): 924–41
Shah MB, Martin JE, Schroeder TJ, et al. The evaluation of the safety and tolerability of two formulations of cyclosporine: Neoral and Sandimmune. A meta-analysis. Transplantation 1999; 67: 1411–7
European FK506 Multicentre Liver Study Group. Randomised trial comparing tacrolimus (FK506) and cyclosporin in prevention of liver allograft rejection. Lancet 1994 Aug 13; 344: 423–8
The U.S. Multicenter FK506 Liver Study Group. A comparison of tacrolimus (FK506) and cyclosporine for immunosuppression in liver transplantation. N Engl J Med 1994 Oct 27; 331: 1110–5
Komolmit P, Davies MH. Tacrolimus in liver transplantation. Expert Opin Invest Drug 1999 Aug; 8: 1239–54
Turner CD, Bruce DS, Cronin DC, et al. Tacrolimus therapy for refractory acute renal allograft rejection: a 4-year experience with an aggressive approach. Transplant Proc 1998 Jun; 30: 1234–5
Carl S, Dörsam J, Mandelbaum A, et al. Combining FK 506 and mycophenolate mofetil for the treatment of acute corticosteroid-resistant rejection following kidney transplantation: a new therapeutic concept. Transplant Proc 1998 Jun; 30: 1236–7
The Canadian Liver Transplant Study Group. The Canadian Prograf in liver transplant trial: the one-year composite outcome [abstract no. 47]. Transplantation 1998; 65(12): S14
Fisher RA, Ham JM, Marcos A, et al. A prospective randomized trial of mycophenolate mofetil with Neoral or tacrolimus after orthotopic liver transplantation. Transplantation 1998 Dec 27; 66: 1616–21
Klupp J, Glanemann M, Bechstein WO, et al. Mycophenolate mofetil in combination with tacrolimus versus Neoral after liver transplantation. Transplant Proc 1999 Feb-Mar; 31: 1113–4
Rolles K, Davidson BR, Burroughs AK. A pilot study of immunosuppressive monotherapy in liver transplantation: tacrolimus versus microemulsified cyclosporin. Transplantation 1999; 68: 1195–209
Stegall MD, Wachs ME, Everson G, et al. Prednisone withdrawal 14 days after liver transplantation with mycophenolate: a prospective trial of cyclosporine and tacrolimus. Transplantation 1997 Dec 27; 64: 1755–60
Zervos XA, Weppler D, Fragulidis GP, et al. Comparison of tacrolimus with microemulsion cyclosporine as primary immunosuppression in hepatitis C patients after liver transplantation. Transplantation 1998 Apr 27; 65: 1044–6
Pichlmayr R, Winkler M, Neuhaus P, et al. Three-year follow-up of the European Multicenter Tacrolimus (FK506) Liver Study. Transplant Proc 1997; 29(5): 2499–502
Wiesner RH. A long-term comparison of tacrolimus (FK506) versus cyclosporine in liver transplantation: a report of the United States FK506 Study Group. Transplantation 1998; 66: 493–9
Fung JJ, Eliasziw M, Todo S, et al. The Pittsburgh randomized trial of tacrolimus compared to cyclosporine for hepatic transplantation. J Am Coll Surg 1996 Aug; 183: 117–25
Jonas S, Guckelberger O, Bechstein WO, et al. Five-year fol-low-up of tacrolimus as primary immunosuppressant after liver transplantation. Transplant Proc 1998 Aug; 30: 2179–81
Busuttil RW, Holt CD. Tacrolimus (FK506) is superior to cyclosporine in liver transplantation. Transplant Proc 1997 Feb–Mar; 29: 534–8
Aziz WI, Gordon FD, Chopra S, et al. Incidence of acute cellular rejection in liver transplant recipients for familial amyloidotic polyneuropathy. FK 506 vs cyclosporine [abstract]. Gastroenterology 1997 Apr; 112 Suppl.: 1217
Ghobrial RM, Farmer DG, Holt C, et al. Tacrolimus versus cyclosporine immunosuppression in liver transplantation for hepatitis C [abstract]. Transplantation 1999 May 15; 67: S587
Lohmann R, Langrehr JM, Klupp J, et al. Quadruple induction therapy including antithymocyte globulin or interleukin-2 receptor antibody or FK 506-based induction therapy after liver transplantation. Transplant Proc 1999 Feb–Mar; 31: 380
Mueller AR, Platz K-P, Willimski C, et al. Influence of immunosuppression on patient outcome after liver transplantation. Transplant Proc 1998 Jun; 30: 1495–6
Ramirez CB, Sebayel MI, Kizilisik T. Early steroid withdrawal after liver transplantation. Transplant Proc 1998 Nov; 30: 3182–3
Van Buren D, Payne J, Geevarghese S, et al. Impact of Sand-immune, Neoral, and Prograf on rejection incidence and renal function in primary liver transplant recipients. Transplant Proc 1998 Aug; 30: 1830–2
Tchervenkov JI, Metrakos P, Barkun J, et al. Rejection rate and cost of maintenance immunosuppression is reduced when using tacrolimus compared to Neoral based immunosuppression in liver transplant recipients [abstract]. Hepatology 1998 Oct; 28 (Pt 2) Suppl.: 355A
Vogt DP, Mayes JT, Henderson JM. FK506 vs cyclosporine as primary immunosuppression in liver transplant patients [abstract]. Hepatology 1997 Oct; 26 (Pt 2) Suppl.: 624A
Neuhaus P, Langrehr JM, Williams R, et al. Tacrolimus-based immunosuppression after liver transplantation: a randomised study comparing dual versus triple low-dose oral regimens. Transpl Int 1997; 10: 253–61
Samuel D, Bismuth H, Boillot O, et al. Tacrolimus (FK506)-based dual versus triple therapy following liver transplantation. Transplant Proc 1998 Jun; 30: 1394–6
Jain AB, Fung JJ, Hamad I, et al. Adult primary liver transplantation: prospective randomized trial of tacrolimus and steroid vs tacrolimus, steroid and mycophenolate mofetil [abstract no. 6]. Transplantation 1998 Oct 27; 66: S2
Eckhoff DE, McGuire BM, Frenette LR, et al. Tacrolimus (FK506) and mycophenolate mofetil combination therapy versus tacrolimus in adult liver transplantation. Transplantation 1998 Jan 27; 65: 180–7
Rudich SM, Riegler JL, Perez RV, et al. Immunosuppression using tacrolimus, mycophenolate, and prednisone following orthotopic liver transplantation: a single-center experience. Transplant Proc 1998 Jun; 30: 1417–8
Klupp J, Bechstein WO, Pratschke J, et al. Risk and benefit of antibody induction therapy in combination with tacrolimus immunosuppression after liver transplantation. Transplant Proc 1998 Jun; 30: 1443–4
Jain A, Reyes J, Kashyap R, et al. Liver transplantation under tacrolimus in infants, children, adults, and seniors: long-term results, survival, and adverse events in 1000 consecutive patients. Transplant Proc 1998 Jun; 30: 1403–4
Jain AB, Kashyap R, Rakela J, et al. Primary adult liver transplantation under tacrolimus: more than 90 months actual follow-up survival and adverse events. Liver Transpl Surg 1999 Mar; 5: 144–50
Abe M, Fuchinoue S, Koike T, et al. Successful prednisone withdrawal after living-related liver transplantation. Transplant Proc 1998 Jun; 30: 1441–2
Jain AB, Rohal S, Madariaga J, et al. Reasons for long-term steroid use following primary adult liver transplantation under tacrolimus [abstract]. Transplantation 1999 May 15; 67: S601
Margarit C, Rimola A, Gonzalez-Pinto I, et al. Efficacy and safety of oral low-dose tacrolimus treatment in liver transplantation. Transpl Int 1998; 11 Suppl. 1: S260–6
Tanaka K, Inomata Y, Uemoto S. A prospective trial of corti-costeroid withdrawal in tacrolimus base-line immunosuppression in living related liver transplantation [abstract]. 7th Alexis Carrel Conference 1998 Oct 20: Kyoto, 50
Ringe B, Braun F, Lorf T, et al. Tacrolimus and mycophenolate mofetil in clinical liver transplantation: experience with a steroid-sparing concept. Transplant Proc 1998 Jun; 30: 1415–6
Mayes JT, Vogt DP, Farquhar ML, et al. Cumulative success in steroid withdrawal using tacrolimus (FK) based immunosuppression for liver transplantation (OLT) [abstract]. Hepatology 1997 Oct; 26 (Pt 2) Suppl.: S235
Buell JF, Grewal HP, Kristo B, et al. Early corticosteroid withdrawal with tacrolimus and mycophenolate mofetil (MMF) immuno-suppression in renal transplantation: eighteen-month follow-up [abstract]. Transplantation 1999 May 15; 67: S545
Busuttil RW, U.S. Multicenter FK 506 Liver Study Group. FK506 (tacrolimus, Prograf Rm) as rescue therapy in liver transplant patients with drug-resistant immune rejection [abstract]. Hepatology 1995 Oct; 22 (4 Pt 2): 398
Sher L, Cosenza CA, Michel J, et al. Efficacy of tacrolimus as rescue therapy for chronic rejection in orthotopic liver transplantation. Transplantation 1997 Jul 27; 64(2): 258–63
Fung JJ, Todo S, Tzakis A, et al. Conversion of liver allograft recipients from cyclosporine to FK 506-based immunosuppression: benefits and pitfalls. Transplant Proc 1991 Feb; 23: 14–21
Jain A, Demetris J, Rakela J, et al. Conversion from cyclosporine to tacrolimus for chronic liver allograft rejection: more than eight years actual follow-up [abstract no. 233]. Hepatology 1998; 28 (4 Pt 2): 221A
Samuel D, Ladouzi A, Reynes M. Tacrolimus rescue therapy for rejection in liver transplantation: experience in 104 patients [abstract]. Gut 1997 Oct; 41 Suppl. 3: A239–40
Hung CM, Jeng L-B, Yeh C-N, et al. Tacrolimus to rescue refractory hepatic allograft rejection: a collaborative study in Taiwan. Transplant Proc 1998 Nov; 30(7): 3589
Millis JM, Cronin DC, Newell KA, et al. Successful use of tacrolimus for initial rejection episodes after liver transplantation. Transplant Proc 1998 Jun; 30: 1407–8
Taibi A, Adham M, Ducerf C, et al. Rescue FK506 therapy for acute rejection and early chronic rejection after liver transplantation: report of 14 cases. Transplant Proc 1998 Jun; 30: 1411–2
Lo CM, Fan ST, Liu CL, et al. Use of FK506 as primary or rescue therapy after liver transplantation in Hong Kong. Transplant Proc 1998 Nov; 30: 3587–8
McDiarmid SV, Klintmalm GB, Busuttil RW. FK506 conversion for intractable rejection of the liver allograft. Transpl Int 1993 Nov; 6: 305–12
Rucay P, Samuel D, Farges O, et al. FK506 as treatment of late acute rejection in liver transplant patients. Transplant Proc 1995 Feb; 27: 1105–6
Winkler M, Ringe B, Jost U, et al. Conversion from cyclosporin to FK 506 after liver transplantation. Transpl Int 1993 Nov; 6: 319–24
Reggiani P, Orsenigo R, Gatti S, et al. Conversion to rescue therapy with FK 506: data from eight liver transplant patients. Transplant Proc 1994 Dec; 26: 3597–8
Pratschke J, Neuhaus R, Tullius SG, et al. Treatment of cyclosporine-related adverse effects by conversion to tacrolimus after liver transplantation. Transplantation 1997 Sep 27; 64: 938–40
Klein A. Tacrolimus rescue in liver transplant patients with refractory rejection or intolerance or malabsorption of cyclosporine. The US Multicenter FK506 Liver Study Group. Liver Transpl Surg 1999; 5(6): 502–8
Jain A, Fung JJ, Todo S, et al. More than six years actual follow-up: conversion from cyclosporine to tacrolimus for chronic liver allograft rejection [abstract]. Hepatology 1996 Oct; 24 (4 Pt 2): 181
McDiarmid SV, Busuttil RW, Ascher NL, et al. FK506 (tacrolimus) compared with cyclosporine for primary immunosuppression after pediatric liver transplantation: results from the U.S. Multicenter Trial. Transplantation 1995 Feb 27; 59: 530–6
Todo S, Fung JJ, Starzl TE, et al. Single-center experience with primary orthotopic liver transplantation with FK 506 immunosuppression. Ann Surg 1994 Sep; 220: 297–309
Reyes J, Jain A, Mazariegos G, et al. Primary liver transplantation in children under tacrolimus and cyclosporine: comparative study [abstract]. Hepatology 1998 Oct; 28 (Pt 2) Suppl. 1: 351A
Jain A, Mieles L, Todo S, et al. Primary liver transplantation in children under tacrolimus [abstract]. Pediatr Nephrol 1996 Aug; 10: C78
Inomata Y, Tanaka K, Egawa H, et al. The evolution of immunosuppression with FK506 in pediatric living-related liver transplantation. Transplantation 1996 Jan 27; 61: 247–52
McDiarmid SV, Busuttil RW. Primary immunosuppressive therapy with tacrolimus after pediatric liver transplantation [abstract]. Pediatr Nephrol 1996 Aug; 10: C41
McDiarmid S, Goss J, Seu P, et al. One hundred children treated with tacrolimus after primary orthotopic liver transplantation. Transplant Proc 1998 Jun; 30: 1397–8
Prabhakaran K, Wise B, Lau HT, et al. Use of tacrolimus (FK-506) in the pediatrie liver transplant recipient [abstract]. Pediatrics 1998 Sep; 102 (Pt 2) Suppl.: 799
Cacciarelli TV, Dvorchik I, Jain A, et al. An analysis of pretransplant variables associated with long-term graft outcome in pediatrie liver transplant recipients receiving primary tacrolimus therapy [abstract]. Transplantation 1998 Jun 27; 65: S89
McKee M, Mattei P, Schwarz K, et al. Steroid withdrawal in tacrolimus (FK506)-treated pediatrie liver transplant recipients. J Pediatr Surg 1997 Jul; 32: 973–5
McDiarmid SV, The US Multicenter FK506 Liver Study Group. Long-term experience with tacrolimus in rescue of pediatrie liver transplant patients [abstract no. 164]. 16th International Congress of the Transplantation Society, Barce-lona; 346
Reyes J, Jain A, Mazariegos G, et al. Conversion of pediatric liver allograft recipients from cyclosporin to tacrolimus based immunosuppression: mean seven years follow-up [abstract no. 754]. Hepatology 1998; 28 (4 Pt 2): 351A
Gridelli B, Colledan M, Lucianetti A, et al. Frequency of switch from cyclosporine to FK 506 before and after Neoral use in pediatric liver transplantation. Transplant Proc 1998 Aug; 30: 1861–2
Reggiani P, Gridelli B, Colledan M, et al. Rescue FK506 early conversion for refractory rejection after pediatric liver translantation: experience in 20 children. Transpl Int 1998; 11 Suppl. 1: S272–4
Egawa H, Esquivel CO, So SK, et al. FK506 conversion therapy in pediatric liver transplantation. Transplantation 1994 Apr; 57: 1169–73
Reding R, Wallemacq P, de Ville de Goyet J, et al. Rescue tacrolimus therapy for refractory rejection after pediatric liver transplantation: a 6-year experience in 47 children [abstract]. Pediatr Nephrol 1996 Aug; 10: C41
Bhatnagar V, Dhawan A, Rela M, et al. Experience with FK506 conversion therapy for liver allograft rejection in children [abstract]. Gut 1994; 35 Suppl. 2: 21
Johnson C, Ahsan N, Gonwa T, et al. Randomized trial of tacrolimus (Prograf) in combination with azathioprine or mycophenolate mofetil versus cyclosporine (Neoral) with mycophenolate mofetil after cadaveric kidney transplantation. Transplantation. In press
Jurewicz WA. Immunological and nonimmunological risk fac-tors with tacrolimus and Neoral in renal transplant recipients: an interim report. Transplant Proc 1999; 31 Suppl. 7A: 64–6S
Morris-Stiff G, Khan A, Quiroga I, et al. Immunosuppression in renal transplantation [letter]. BMJ 1999; 319: 1136
Mayer AD, Dmitrewski J, Squifflet J-P, et al. Multicenter randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection: a report of the European Tacrolimus Multicenter Renal Study Group. Transplantation 1997; 64(3): 436–43
Mayer AD, for the European Tacrolimus Multicentre Renal Study Group. Four-year follow-up of the European Tacrolimus Multicentre Renal Study. Transplant Proc 1999; 31 Suppl. 7A: 27S–8S
Pirsch JD, Miller J, Deierhoi MH, et al. A comparison of tacrolimus (FK506) and cyclosporine for immunosuppression after cadaveric renal transplantation. FK506 Kidney Transplant Study Group. Transplantation 1997 Apr 15; 63(7): 977–83
Jensik SC, FK 506 Kidney Transplant Study Group. Tacrolimus (FK 506) in kidney transplantation: three-year survival results of the US multicenter, randomized, comparative trial. Transplant Proc 1998 Jun; 30(4): 1216–8
Yang HC, Holman MJ, Langhoff E, et al. Tacrolimus/“low-dose” mycophenolate mofetil versus microemulsion cyclo-sporine/“low-dose” mycophenolate mofetil after kidney transplantation -1-year follow-up of a prospective, randomized clinical trial. Transplant Proc 1999 Feb–Mar;31: 1121–4
Vincenti F, Laskow DA, Neylan JF. One year follow-up of an open-label trial of FK506 for primary kidney transplantation. Transplantation 1996 Jun 15; 61: 1576–81
Schleibner S, Krauss M, Wagner K, et al. FK 506 versus cyclosporin in the prevention of renal allograft rejection —European pilot study: six-week results. Transpl Int 1995; 8(2): 86–90
Shapiro R, Jordan M, Scantlebury V, et al. FK506 in clinical kidney transplantation. Transplant Proc 1991; 23: 3065–7
Hattori R, Ohshima S, Ono Y, et al. FK 506 in cadaveric kidney transplantation from non-heart-beating donors. Transplant Proc 1998 Nov; 30: 3801–3
Zapanta R, Aswad S, Shidban H, et al. Cyclosporine vs FK506 on renal transplant recipient, a single center experience [abstract]. Nephrol Dial Transplant 1998 Jun; 13: A259
Daoud AJ, Schroeder TJ, Shah M, et al. A comparison of the safety and efficacy of mycophenolate mofetil, prednisone and cyclosporine and mycophenolate mofetil, and prednisone and tacrolimus. Transplant Proc 1998 Dec; 30: 4079–81
Kinukawa T, Ohshima S, Ono Y, et al. Long-term comparison of tacrolimus and cyclosporine-based immunosuppression in kidney recipients with grafts from non-heart-beating cadaver donor. Transplant Proc 1998 Jun; 30: 1227–9
Pirsch JD, D’Alessandro AM, Knechtle SJ, et al. Tacrolimus and retransplantation: equivalent results to primary renal transplantation [abstract]. Transplantation 1998 Jun 27; 65: S167
Ochiai T, Fukao K, Takahashi K, et al. Phase III study of FK 506 in kidney transplantation. Transplant Proc 1995 Feb; 27: 829–33
Miura S, Okazaki H, Sato T, et al. Effect of tacrolimus on the outcome of renal transplantation with donor-specific blood transfusion. Transplant Proc 1998 Jun; 30: 1212–3
Miura S, Okazaki H, Sato T, et al. The beneficial effects of FK 506 on living-related renal transplantation in presensitized recipients. Transplant Proc 1999 Aug; 31: 1973–5
Kokado Y, Takahara S, Kyo M, et al. Low-dose tacrolimus (FK506)-based immunosuppressive protocol in living donor renal transplantation. Transplant Proc 1999 Feb–Mar; 31: 1151–4
Knoll GA, Bell RC. Tacrolimus versus cyclosporin for immu-nosuppression in renal transplantation: meta-analysis of randomised trials. BMJ 1999 Apr 24; 318: 1104–7
Hauser IA, Neumayer HN. Tacrolimus and cyclosporine efficacy in high-risk kidney transplantation: European Multi-centre Tacrolimus (FK506) Renal Study Group. Transpl Int 1998; 11 Suppl. l: S73–7
Weber M, Deng S, Arenas J, et al. Decreased rejection episodes in African-American renal transplant recipients receiving mycophenolate mofetil/ tacrolimus therapy. Transplant Proc 1997 Dec; 29: 3669–70
Opelz G. Immunosuppression with FK 506 does not improve kidney graft survival. Collaborative Transplant Study. Transplant Proc 1999 Feb–Mar; 31(1-2): 1147–8
Gjertson DW, Cecka JM, Terasaki PI. The relative effects of FK506 and cyclosporine on short-and long-term kidney graft survival. Transplantation 1995 Dec 27; 60: 1384–8
Opelz G, for the Collaborative Transplant Study. Effect of im-munosupressive therapy on graft half-life projections. Transplant Proc 1999; 31 Suppl. 7A: 31S–3S
Chang RWS, Fernando O, Kashi S, et al. European multicenter study comparing a dual vs. triple low-dose tacrolimus regimen in renal transplantation [abstract]. Transplantation 1999 Aprl5; 67: S157
Shapiro R, Jordan ML, Scantlebury VP, et al. A prospective, randomized trial of tacrolimus/prednisone versus tacrolimus/prednisone/mycophenolate mofetil in renal transplant recipients. Transplantation 1999 Feb 15; 67: 411–5
Miller J, FK506/MMF Dose-Ranging Kidney Transplant Study Group. Tacrolimus and mycophenolate mofetil in renal transplant recipients: one year results of a multicenter, randomized dose ranging trial. Transplant Proc 1999 Feb–Mar; 31: 276–7
The French Tacrolimus Renal Transplantation Study Group. Tacrolimus in renal transplantation: a comparison of induction vs noninduction therapy (triple therapy): three-month results. Transplant Proc 1999 Feb–Mar; 31: 330–1
Aswad S, Zapanta R, Wu L, et al. Steroid withdrawal in living related kidney transplant patients receiving FK506 [abstract]. Nephrol Dial Transplant 1998 Jun; 13: A285
Forsythe J, for the European Multicentre Tacrolimus/MMF Study Group. Tacrolimus and mycophenolate mofetil in cadaveric renal transplant recipients. Transplant Proc 1999; 31 Suppl. 7A: 69S–71S
Shapiro R, Jordan ML, Scantlebury VP, et al. A prospective, randomised trial of FK 506/prednisone vs FK 506/azathioprine/prednisone in renal transplant patients. Transplant Proc 1995 Feb; 27: 814–7
Shapiro R, Jordan ML, Scantlebury VP, et al. Tacrolimus in renal transplantation. Transplant Proc 1996 Aug; 28: 2117–8
Bonomini V, for The Italian-Spanish Tacrolimus Study Group. Low rejection rates with tacrolimus-based dual and triple regimens following renal transplantation [abstract no A3647]. J Am Soc Nephrol 1999; 10: 720A
Shapiro R, Jordan ML, Scantlebury VP, et al. Outcome after steroid withdrawal in renal transplant patients receiving tacrolimus-based immunosuppression. Transplant Proc 1998 Jun; 30: 1375–7
Schneeberger H, Zanker B, Hillebrand G, et al. Tacrolimus as a primary immunosuppressive therapy in cadaveric renal transplantation: five years’ experience at a single center. Transplant Proc 1998 Jun; 30: 1598–9
Yoshimura N, Oka T, Ohmori Y, et al. Combination therapy of tacrolimus (FK506) with azathioprine and steroids in renal transplant recipients. Transplant Proc 1998 Feb; 30: 33–5
Cheng HM, Wong FK, Choi KS, et al. Primary prophylaxis with tacrolimus in kidney transplants in China. Transplant Proc 1998 Nov; 30: 3590–1
Xenos ES, Ciancio G, Burke GW. The use of tacrolimus as induction and maintenance immunosuppression in renal cadaveric transplant recipients over the age of 60. Clin Transpl 1997 Oct; 11 (Pt 2): 497–9
Takahashi K, Saito K, Sonda K, et al. Tacrolimus therapy for ABO-incompatible kidney transplantation. Transplant Proc 1998 Jun; 30: 1219–20
Eghtesad B, Malhotra D, Hecker WP, et al. Use of tacrolimus as the primary immunosuppression after renal transplant in Native Americans and Hispanics. Transplant Proc 1998 Jun; 30: 1232–3
Braun F, Lorf T, Grupp C, et al. Primary low-dose tacrolimus immunosuppressive prophylaxis for high-risk kidney transplant recipients. Transplant Proc 1998 Jun; 30: 1221–3
Golconda MS, Rayhill SC, First MR, et al. Efficacy of a modified daclizumab regimen in preventing acute rejection in kidney and kidney-pancreas transplant recipients [abstract]. Transplantation 1999 Apr 15; 67: S83
Roth D, Kuehnel F, Angelis M, et al. Daclizumab induction for primary kidney transplant recipients using tacrolimus, mycophenolate mofetil and steroids as maintenance immunosuppression [abstract]. Transplantation 1999 May 15; 67: S602
Yokoyama I, Uchida K, Fukao T, et al. FK506: long-term study in kidney transplantation. Transplant Proc 1995 Feb; 27: 818–21
Preston R, Ball S, Cairns T, et al. FK 506 as primary immuno-suppressive therapy in renal transplantation. Transplant Proc 1998 Jun; 30: 1214–5
Tanabe K, Ishikawa N, Tokumoto T, et al. Long-term results of living kidney transplantation under tacrolimus immunosuppression: a single-center experience. Transplant Proc 1998 Jun; 30: 1224–6
Oliveira DBG, Chang R. Report of the first 118 tacrolimus-treated patients at St George’s Hospital, London. Transplant Proc 1999; 31 Suppl. 7A: 61S–3S
Grewal HP, Thistlethwaite Jr JR, Loss GE, et al. Corticosteroid cessation 1 week following renal transplantation using tacrolimus/mycophenolate mofetil based immunosuppression. Transplant Proc 1998 Jun; 30: 1378–9
Woodle ES, Buell J, Siegel C, et al. Corticosteroid withdrawal under tacrolimus primary and rescue therapy in renal transplantation: the Chicago experience. Transplant Proc 1999; 31 Suppl. 7A: 84S–5S
Kaufman DB, Stuart J, Leventhal JR, et al. Steroid avoidance in kidney transplantation [abstract]. Transplantation 1999 May 15; 67: S619
Jordan ML, Naraghi R, Shapiro R, et al. Tacrolimus for rescue of refractory renal allograft rejection. Transplant Proc 1998 Jun; 30: 1257–60
Woodle ES, Thistlethwaite JR, Gordon JH, et al. A multicenter trial of FK506 (tacrolimus) therapy in refractory acute renal allograft rejection: a report of the Tacrolimus Kidney Transplantation Rescue Study Group. Transplantation 1996 Sep 15; 62: 594–9
Heemann U, Behrend M, Friedrich J, et al. Efficacy of tacrolimus rescue therapy following kidney transplantation [abstract]. Nephrol Dial Transplant 1996 Jun; 11: A279
Felldin M, Bäckman L, Brattström C, et al. Rescue therapy with tacrolimus (FK 506) in renal transplant recipients: a Scandinavian multicenter analysis. Transpl Int 1997 Jan; 10: 13–8
Kliem V, Radermacher J, Hiss M, et al. Conversion to tacrolimus for acute corticosteroid-and antibody-resistant rejection following kidney transplantation. Transplant Proc 1999; 31 Suppl. 7A: 37S–40S
Maroun T, Aubert P, Baron C, et al. Rejection therapy with tacrolimus in renal transplantation: preliminary results of a collaborative multicenter study in 45 patients. Transplant Proc 1998 Sep; 30: 2811–2
Morris-Stiff G, Talbot D, Balaji V, et al. Conversion of renal transplant recipients from cyclosporin to low-dose tacrolimus for refractory rejection. Transpl Int 1998; 11 Suppl. 1: S78–81
Witzke O, Becker G, Erhard J, et al. Tacrolimus rescue therapy in patients with rejection and long-term dialysis after kidney transplantation. Clin Nephrol 1998 Jan; 49: 24–7
Morris-Stiff G, Talbot D, Balaji V, et al. Conversion of renal transplant recipients from cyclosporin (Neoral) to tacrolimus (Prograf) for haemolytic uraemic syndrome. Transpl Int 1998; 11 Suppl. 1: S98–9
Pascual M, Saidman S, Tolkoff-Rubin N, et al. Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation. Transplantation 1998 Dec 15; 66: 1460–4
Shu K-H, Cheng C-H, Wu M-J, et al. A multicenter trial of FK506 as rescue therapy for renal transplant recipients in Taiwan. Transplant Proc 1998 Nov; 30: 3584–6
Lácha J, Krejèová E, Viklicky O, et al. Rescue therapy using FK-506 and a combination of FK 506 with mycophenolate mofetil after renal transplantation [abstract]. Nephrol Dial Transplant 1998 Jun; 13: A257
Morris-Stiff G, Baboolal K, Singh J, et al. Conversion from cyclosporine to tacrolimus in renal allograft recipients with chronic graft nephropathy: preliminary report. Transplant Proc 1998 Jun; 30: 1245–6
Budde K, Smettan S, Fritsche L, et al. Long-term outcome of tacrolimus rescue therapy in late rejection after renal transplantation. Transplant Proc 1998 Aug; 30: 1780–1
Loss Jr GE, Grewal HP, Siegel CT, et al. Reversal of delayed hyperacute renal allograft rejection with a tacrolimus-based therapeutic regimen. Transplant Proc 1998 Jun; 30: 1249–50
Busque S, Demers P, St Louis G, et al. Conversion from Neoral (cyclosporine) to tacrolimus of kidney transplant recipients for gingival hyperplasia or hypertrichosis. Transplant Proc 1998 Jun; 30: 1247–8
Burrows L, Knight R, Genyk Y, et al. Conversion to tacrolimus to ameliorate cyclosporine toxicity in kidney recipients. Transplant Proc 1998 Aug; 30: 2030–2
Kohnle M, Linkes P, Zimmermann U, et al. Conversion from cyclosporine to tacrolimus in renal transplant recipients with gum hyperplasia. Transplant Proc 1999; 31 Suppl. 7A: 44S–5S
Shapiro R, Scantlebury VP, Jordan ML, et al. Pediatric renal transplantation under tacrolimus-based immunosuppression. Transplantation 1999 Jan 27; 67: 299–303
Ellis D, Shapiro R, Jordan ML, et al. Comparison of FK-506 and cyclosporine regimens in pediatric renal transplantation. Pediatr Nephrol 1994 Apr; 8: 193–200
McKee M, Segev D, Wise B, et al. Initial experience with FK506 (tacrolimus) in pediatric renal transplant recipients. J Pediatr Surg 1997 May; 32(5): 688–90
Schroeder TJ, First MR, Gaber AO. Monitoring and management of immunosuppression in paediatric transplant patients. Clin Immunother 1995 Dec; 4: 425–44
Offner G, Latta K, Bökenkamp A, et al. Tacrolimus for rescue of renal transplantation in children [abstract]. Pediatr Nephrol 1996 Aug; 10: C42
Corey HE, Tellis V, Schechner R. Improved renal allograft survival in children treated with FK 506 (tacrolimus) rescue therapy. Pediatr Nephrol 1996 Dec; 10: 720–2
Shapiro R, Scantlebury VP, Jordan ML, et al. FK506 in pediatric kidney transplantation —primary and rescue experience. Pediatr Nephrol 1995; 9 Suppl.: 43–8
Birk PE, Cook ME, Schmidt WJ, et al. Preliminary experience with FK 506 in pediatric renal transplant recipients: a single-center report. Transplant Proc 1996 Apr; 28: 993–4
Distant D, Navarro J, Akoad M, et al. Successful tacrolimus rescue in cyclosporine treated pediatric renal transplant recipients [abstract no 128]. In: 3rd International Congress on Pediatric Transplantation. 2nd ed. 1998 Jul 8–10; Boston; Ped Transplant 1998; 2 Suppl. 1: 62
Berg U, Bohlin AB, Tyden G. Renal function after switch from the microemulsion formulation of cyclosporine to tacrolimus in children after renal transplantation (TX) [abstractno. 126]. In: 3rd International Congress on Pediatric Transplantation. 2nd ed. 1998 Jul 8–10; Boston; Ped Transplant 1998; 2 Suppl. 1: 62
Guest G, Charbit M, Droz D, et al. Tacrolimus (FK 506) after a pediatric renal transplant [in French]. Ann Pediatr 1999 Feb; 46: 85–9
Peretti N, Koch-Nogueira PC, Dubourg L, et al. Effect of tacrolimus in second intention in pediatric kidney transplant patients (retrospective study) [in French; abstract]. First National Congress of the French Society of Pediatrics. 5th ed. 1998 Apr 23–25; Amiens: 236S
Filler G, Strehlau J, Von Bredow MA, et al. Tacrolimus in der Nierentransplantation: Erfahrungen in einem Kinderneph-rologischen Zentrum. In: Land W, Ringe B, editors. Tacrolimus in der Nierentransplantation. Lengerich: Pabst Scientific Publishers, 1997: 113–26
Hulton SA, Milford DV, Taylor CM, et al. Experience of tacrolimus (Prograf) in paediatric renal transplantation [abstract no. 06]. 31st Annual Meeting of the European Society for Paediatric Nephrology. 11th ed. 1997 Sep 27–30; Athens; C16
Callis L, Vila A, Salva A, et al. Results of FK 506 in sixteen renal-transplanted paediatric patients [abstract no. P7]. 31st Annual Meeting of the European Society for Paediatric Nephrology. 11th ed. 1997 Sep 27–30; Athens, C34
Meiser BM, Überfuhr P, Fuchs A, et al. Single-center random-ized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of acute myocardial rejection. J Heart Lung Transplant 1998 Aug; 17: 782–8
Pham SM, Kormos RL, Hattler BG, et al. A prospective trial of tacrolimus (FK 506) in clinical heart transplantation: intermediate-term results. J Thorac Cardiovasc Surg 1996 Apr; 111: 764–72
Reichart B, Meiser B, Vigano M, et al. European Multicenter Tacrolimus (FK506) Heart Pilot Study: one-year results -European Tacrolimus Multicenter Heart Study Group. J Heart Lung Transplant 1998 Aug; 17: 775–81
Taylor DO, Barr ML, Radovancevic B, et al. A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation: decreased hyperlipidemia and hypertension with tacrolimus. J Heart Lung Transplant 1999 Apr; 18: 336–45
Rinaldi M, Pellegrini C, Martinelli L, et al. FK506 effectiveness in reducing acute rejection after heart transplantation: a prospective randomized study. J Heart Lung Transplant 1997 Oct; 16: 1001–10
Mid-and longterm results of a prospective trial comparing tacrolimus and cyclosporin in heart transplantation. Adv Im-munosuppression 1999 June; 7 Suppl. 1: 5
Meiser BM, Pfeiffer M, Schmidt D, et al. The efficacy of the combination of tacrolimus and mycophenolate mofetil for prevention of acute myocardial rejection is dependent on routine monitoring of mycophenolic acid trough acid levels. Transplant Proc 1999 Feb–Mar; 31: 84–7
Rinaldi M, for the European Tacrolimus Heart Study Group. Safety evaluation of a randomised, multicentre dose finding study of tacrolimus in cardiac transplantation [abstract no.38]. J Heart Lung Transplant 2000; 19(1): 47
Madden BP, for the European Tacrolimus Heart Study Group. Results of tacrolimus in cardiac transplantation following intravenous tacrolimus administration [abstract no 273]. J Heart Lung Transplant 2000; 19(1): 102
Mentzer Jr RM, Jahania MS, Lasley RD, et al. Tacrolimus as a rescue immunosuppressant after heart and lung transplantation. Transplantation 1998 Jan 15; 65: 109–13
Meiser BM, Überfuhr P, Fuchs A, et al. Tacrolimus: a superior agent to OKT3 for treating cases of persistent rejection after intrathoracic transplantation. J Heart Lung Transplant 1997 Aug; 16: 795–800
Onsager DR, Canver CC, Jahania MS, et al. Efficacy of tacrolimus in the treatment of refractory rejection in heart and lung transplant recipients. J Heart Lung Transplant 1999 May; 18: 448–55
Mathieu P, Carrier M, White M, et al. Replacement of cyclosporin A for FK-506 following heart transplantation [abstract]. Can J Cardiol 1998 Sep; 14 Suppl. F: 166F
Lowes BD, Wolfel EE, Rizeq MN, et al. FK506 is a safe and effective treatment for moderate rejection in heart transplant recipients [abstract]. Transplantation 1998 Jun 27; 65: S155
Marcus N, Khaghani A, Burke M, et al. Medium term outcome of tacrolimus immunosuppression following rejection or graft dysfunction in heart transplant patients. Transplant Proc 1998 Jun; 30: 1134–5
Ko WJ, Chou NK, Chen YS, et al. Clinical trial of FK506 in heart transplant patients in Taiwan: report of 7 cases with immunosuppression switch from cyclosporine to FK506. Transplant Proc 1998 Nov; 30: 3339–41
Armitage JM, Fricker FJ, del Nido P, et al. A decade (1982 to 1992) of pediatric cardiac transplantation and the impact of FK-506 immunosuppression. J Thorac Cardiovasc Surg 1993 Mar; 105: 464–73
Herzberg GZ, Rossi AF, Courtney M, et al. The effects of HLA mismatching and immunosuppressive therapy on early rejection outcome in pediatric heart transplant recipients. J Heart Lung Transplant 1998 Dec; 17: 1195–200
Swenson JM, Fricker FJ, Armitage JM. Immunosuppression switch in pediatric heart transplant recipients: cyclosporine to FK 506. J Am Coll Cardiol 1995 Apr; 25: 1183–8
Walker RE, McCrindle BW, Coles JG, et al. Clinical outcomes associated with conversion to tacrolimus-based immunosuppression in pediatric cardiac transplantation. Transplant Proc 1998 Jun; 30: 1116–7
Keenan RJ, Konishi H, Kawai A, et al. Clinical trial of tacrolimus versus cyclosporine in lung transplantation. Ann Thorac Surg 1995 Sep; 60: 580–5
Keenan RJ, Dauber JH, Iacono AT, et al. Long term followup-clinical trial of tacrolimus versus cyclosporine for lung transplantation [abstract]. J Heart Lung Transplant 1998 Jan; 17: 58
Reichenspurner H, Kur F, Meiser BM, et al. Optimalization of immunosuppression after pulmonary transplantation [abstract]. Transplantation 1998 Suppl.: 264
Reichenspurner H, Kur F, Treede H, et al. Tacrolimus-based immunosuppressive protocols in lung transplantation. Transplant Proc 1999 Feb-Mar; 31: 171–2
Dowling RD, Miller DL. Immunosuppressive therapy for lung transplantation. Clin Immunother 1996 Apr; 5: 253–9
Bolman RM. Advantage-FK 506: reduced chronic rejection for lung transplant recipients. Ann Thorac Surg 1995 Sep; 60: 495–6
Wiebe K, Harringer W, Franke U, et al. FK506 rescue therapy in lung transplantation. Transplant Proc 1998 Jun; 30: 1508–9
Walker S, Habib S, Rose M, et al. Clinical use and bioavailability of tacrolimus in heart-lung and double lung transplant recipients with cystic fibrosis. Transplant Proc 1998 Jun; 30: 1519–20
Horning NR, Lynch JP, Sundaresan SR. Tacrolimus therapy for persistent or recurrent acute rejection after lung transplantation. J Heart Lung Transplant 1998 Aug; 17: 761–7
Lipson DA, Palevsky HI, Kotloff RM, et al. Conversion to tacrolimus (FK506) from cyclosporine after orthotopic lung transplantation. Transplant Proc 1998 Jun; 30: 1505–7
Malouf M, Aboyoun C, Nicholls M, et al. Successful control of steroid refractory pulmonary allograft rejection using tacrolimus (FK506) [abstract]. Respirology 1999 Jan; 4 Suppl.: A34
Jenkins GH, Banner NR, Marshall A, et al. Effect of tacrolimus rescue therapy on blood pressure, cardiac and renal function in cardiac transplant recipients [abstract]. J Hum Hypertens 1997 Sep; 11: 615–6
Ross DJ, Lewis MI, Kramer M, et al. FK 506 rescue immunosuppression for obliterative bronchiolitis after lung transplantation. Chest 1997 Nov; 112: 1175–9
Kesten S, Chaparro C, Scavuzzo M, et al. Tacrolimus as rescue therapy for bronchiolitis obliterans syndrome. J Heart Lung Transplant 1997 Sep; 16: 905–12
Gruessner RWG. Antibody induction therapy in pancreas transplantation. Transplant Proc 1998 Jun; 30: 1556–9
Bartlett ST, Schweitzer EJ, Johnson LB, et al. Equivalent success of simultaneous pancreas kidney and solitary pancreas transplantation: a prospective trial of tacrolimus immunosuppression with percutaneous biopsy. Ann Surg 1996 Oct; 224: 440–52
Tesi RJ, Byer-Ashe M, Jaspan J. Conversion of pancreas transplants to FK 506 from CsA. Transplant Proc 1995 Dec; 27: 3032–3
Gruessner RWG, Sutherland DER, Drangstveit MB, et al. Mycophenolate mofetil in pancreas transplantation. Transplantation 1998 Aug 15; 66: 318–23
Corry RJ, Shapiro R, Egidi MF, et al. Pancreas transplantation without antibody therapy. Transplant Proc 1998 Mar; 30: 299–300
Burke GW, Ciancio G, Alejandro R, et al. Use of tacrolimus and mycophenolate mofetil for pancreas-kidney transplantation with or without OKT3 induction. Transplant Proc 1998 Jun; 30: 1544–5
Gruessner RWG, Bartlett ST, Burke GW, et al. Suggested guidelines for the use of tacrolimus in pancreas/kidney trans-plantation. Clin Transpl 1998 Jun; 12: 260–2
Gruessner RWG, for the Tacrolimus Pancreas Transplant Study Group. Tacrolimus in pancreas transplantation: a multicenter analysis. Clin Transpl 1997 Aug; 11: 299–312
Graessner RWG, Sutherland DER, Najarian JS, et al. Solitary pancreas transplantation for nonuremic patients with labile insulin-dependent diabetes mellitus. Transplantation 1997 Dec 15; 64: 1572–7
Schulz T, Konzack J, Busing M. Mycophenolate mofetil/ prednisolone/single-shot ATG with tacrolimus or cyclosporine in pancreas/kidney transplantation: first results of an ongoing prospective randomized trial. Transplant Proc 1999 Feb–Mar; 31: 591–2
Stegall MD, Simon M, Wachs ME, et al. Mycophenolate mofetil decreases rejection in simultaneous pancreas-kidney transplantation when combined with tacrolimus or cyclospor-ine. Transplantation 1997 Dec 27; 64: 1695–700
Graessner AC, Sutherland DE. Analysis of United States (US) and non-US pancreas transplants as reported to the International Pancreas Transplant Registry (IPTR) and to the United Network for Organ Sharing (UNOS). Clin Transpl 1998; 12: 53–73
Corry RJ, Egidi MF, Shapiro R, et al. Pancreas transplantation with enteric drainage under tacrolimus induction therapy [abstract]. Transplant Proc 1997 Feb–Mar; 29: 642
Jordan ML, Shapiro R, Gritsch HA, et al. Long-term results of pancreas transplantation under tacrolimus immunosuppression. Transplantation 1999 Jan 27; 67: 266–72
Jordan ML, Luke P, Chakrabarti P, et al. Results of pancreas transplantation following steroid withdrawal under FK506-based immunosuppression [abstract]. Transplantation 1999 May 15; 67: 567
Steurer W, Spechtenhauser B, Ladurner R, et al. Graft pancreatitis is the predominant reason for graft loss in a consecutive series of 35 enteric drained pancreas transplants with FK506 and MMF immunosuppression [abstract]. Transplantation 1999 May 15; 67: S628
Demirbas A, Ciancio G, Burke G, et al. FK 506 in simultaneous pancreas/kidney transplantation: the University of Miami experience. Transplant Proc 1997 Nov; 29: 2903
Sollinger HW, Brace DS, Humar A, et al. Multicenter retro-spective analysis of simultaneous kidney pancreas transplant recipients receiving daclizumab induction [abstract]. Transplantation 1999 May 15; 67: S543
Schulz T, Martin D, Heimes M, et al. Tacrolimus/mycophenolate mofetil/steroid-based immunosuppression after pancreas-kidney transplantation with single shot antithymocyte globulin. Transplant Proc 1998 Jun; 30: 1533–5
Reddy KS, Stratta R, Shokouh-Amiri H, et al. Simultaneous kidney-pancreas transplantation without antilymphocyte induction [abstract]. Transplantation 1998 Jun 27; 65: S175
Lee CM, Scandling JD, Krieger NR. Outcomes in diabetic patients after simultaneous pancreas-kidney versus kidney alone transplantation. Transplantation 1997 Nov 15; 64: 1288–94
Kaufman DB, Leventhal JR, Stuart J, et al. Single-center expe-rience of 60 consecutive simultaneous pancreas-kidney trans-plants using mycophenolate mofetil and tacrolimus as primary maintenance immunotherapy. Transplant Proc 1999 Feb–Mar; 31: 615–6
Peddi VR, Munda R, Demmy AM, et al. Long-term outcome in simultaneous kidney and pancreas transplant receipients with functioning allografts at 1-year posttransplantation. Transplant Proc 1999 Feb–Mar; 31: 608–9
Peddi VR, Demmy AM, Munda R, et al. Tacrolimus eliminates acute rejection as a major complication following simultaneous kidney and pancreas transplantation. Transplant Proc 1998 Mar; 30: 509–11
Kahl A, Lorenz F, Pohle C, et al. Prednisolone withdrawal after pancreas-kidney transplantation in patients treated with tacrolimus and mycophenolate mofetil [abstract]. Transplantation 1999 Apr 15; 67: S223
Ghasemian SR, Light JA, Currier C, et al. Tacrolimus vs Neoral in renal and renal/pancreas transplantation. Clin Transpl 1999 Feb; 13 (Pt 2): 123–5
Bruce DS, Woodle ES, Newell KA, et al. Tacrolimus/ mycophenolate provides superior immunosuppression relative to Neoral/mycophenolate in synchronous pancreas-kid-ney transplantation. Transplant Proc 1998 Jun; 30: 1538–40
Humar A, Parr L, Drangstveit MB, et al. Steroid withdrawal in pancreas transplant recipients [abstract]. Transplantation 1999 Apr 15; 67: S208
Ketel BL, Turton-Weeks S, Reed K, et al. Tacrolimus-based vs cyclosporine-based immunotherapy in combined kidneypancreas transplantation. Transplant Proc 1996 Apr; 28: 899
El-Ghoroury M, Hariharan S, Peddi VR, et al. Efficacy and safety of tacrolimus versus cyclosporine in kidney and pancreas transplant recipients. Transplant Proc 1997 Feb–Mar; 29: 649–51
Odorico JS, Becker YT, Groshek M, et al. Improved solitary pancreas transplant graft survival in the modern immunosup-pressive era [abstract]. Transplantation 1999 May 15; 67: S626
Stratta RJ, et al. for the FKMMFM-CSG. Simultaneous use of tacrolimus and mycophenolate mofetil in combined pancreas-kidney transplant recipients: a multi-center report. Transplant Proc 1997 Feb–Mar; 29: 654–5
Ciancio G, Burke G, Viciana A, et al. Use of intravenous tacrolimus to reverse vascular rejection in kidney and simultaneous kidney-pancreas transplantation. Transplant Proc 1998 Jun; 30: 1536–7
Becker G, Witzke O, Friedrich J, et al. Rescue therapy with tacrolimus in simultaneous pancreas/kidney transplantation. Transpl Int 1997; 10: 51–4
Hariharan S, Peddi VR, Munda R, et al. Long-term renal and pancreas function with tacrolimus rescue therapy following kidney/pancreas transplantation. Transplant Proc 1997 Feb–Mar; 29: 652–3
Goulet O. Intestinal transplantation. Curr Opin Clin Nutr Metab Care 1999; 2: 315–21
Grant D, on behalf of the International Intestinal Transplant Registry. Current results of intestinal transplantation. Lancet 1996 Jun 29; 347: 1801–3
Grant D, on behalf of the Intestinal Transplant Registry. Intes-tinal transplantation: 1997 report of the international registry. Transplantation 1999; 67(7): 1061–4
Goulet O, Jan D, Lacaille F, et al. Intestinal transplantation in children: preliminary experience in Paris. J Parent Enter Nutr 1999; 23(5): S121–5
Abu-Elmagd KM, Reyes J, Fung JJ, et al. Evolution of clinical intestinal transplantation: improved outcome and cost effectiveness. Transplant Proc 1999 Feb–Mar; 31: 582–4
Atkison P, Williams S, Wall W. Results of pediatric small bowel transplantation in Canada. Transplant Proc 1998 Sep; 30: 2521–2
Goulet O, Michel JL, Jobert A, et al. Small bowel transplantation alone or with the liver in children: changes by using FK506. Transplant Proc 1998 Jun; 30: 1569–70
Tzakis AG, Weppler D, Khan MF, et al. Mycophenolate mofetil as primary and rescue therapy in intestinal transplantation. Transplant Proc 1998 Sep; 30: 2677–9
Misiakos EP, Weppler D, Bakonyi A, et al. Clinical outcome of intestinal transplantation at the University of Miami. Transplant Proc 1999 Feb–Mar; 31: 569–71
Gruessner RWG, Sharp HL. Living-related intestinal transplantation: first report of a standardized surgical technique. Transplantation 1997 Dec 15; 64: 1605–7
Abu-Elmagd K, McGhee W, Martin D, et al. The efficacy of daclizumab for intestinal transplantation: preliminary report [abstract]. Transplantation 1999 May 15; 67: 588
Brousse N, Goulet O. Small bowel transplantation: unique problems but now standard treatment for small bowel insufficiency. BMJ 1996 Feb 3; 312: 261–2
Plosker GL, Barradell LB. Cyclosporin: a review of its pharmacological properties and role in the management of graft versus host disease. Clin Immunother 1996 Jan; 5: 59–90
Soutar RL, King DJ. Bone marrow transplantation. BMJ 1995 Jan 7; 310: 31–6
Deeg HJ. Prophylaxis and treatment of acute graft-versus-host disease: current state, implications of new immunopharma-cologic compounds and future strategies to prevent and treat acute GVHD in high-risk patients. Bone Marrow Transplant 1994; 14 Suppl. 4: 56–60
Przepiorka D, Ippoliti C, Khouri I, et al. Tacrolimus and minidose methotrexate for prevention of acute graft-versus-host disease after matched unrelated donor marrow transplantation. Blood 1996 Dec 1; 88: 4383–9
Nash RA, Piñeiro LA, Storb R, et al. FK506 in combination with methotrexate for the prevention of graft-versus-host disease after marrow transplantation from matched unrelated donors. Blood 1996 Nov; 88: 3634–41
Fay JW, Nash RA, Wingard JR, et al. FK 506-based immuno-suppression for prevention of graft versus host disease after unrelated donor marrow transplantation. Transplant Proc 1995 Feb; 27: 1374
Uberti JP, Silver SM, Adams PT, et al. Tacrolimus and methotrexate for the prophylaxis of acute graft-versus-host disease in allogeneic bone marrow transplantation in patients with hematological malignacies. Bone Marrow Transplant 1997 Jun; 19(12): 1233–8
Nash RA, Etzioni R, Storb R, et al. Tacrolimus (FK506) alone or in combination with methotrexate or methylprednisolone for the prevention of acute graft-versus-host disease after marrow transplantation from HLA-matched siblings: a single-center study. Blood 1995 Jun 15; 85: 3746–53
Devine SM, Geller RB, Dix SP, et al. Tacrolimus (FK506) combined with methotrexate is effective in preventing acute graft verses host disease following related donor allogeneic bone marrow transplantation [abstract]. Blood 1995 Nov 15; 86 Suppl. 1: 395
Fay JW, Wingard JR, Antin JH, et al. FK506 (tacrolimus) monotherapy for prevention of graft-versus-host disease after histocompatible sibling allogeneic bone marrow transplantation. Blood 1996 Apr 15; 87: 3514–9
Devine SM, Geller RB, Lin LB, et al. The outcome of unrelated donor bone marrow transplantation in patients with hematologic malignancies using tacrolimus (FK506) and low dose methotrexate for graft-versus-host disease prophylaxis. Biol Blood Marrow Transplant 1997 Apr; 3: 25–33
Reynolds C, Ratanatharathorn V, Adams P, et al. Allogeneic peripheral stem cell transplants in patients with chronic myeloid leukemia using tacrolimus for graft-versus-host disease prophylaxis [abstract]. Blood 1998 Nov 15 (Pt 2) Suppl. 1: 354–5
Ball ED, deMagalhaes-Silverman M, Rybka WR, et al. Allogeneic peripheral blood stem cell transplantation (PBSCT) for hematological malignancy with tacrolimus monotherapy as prophylaxis for graft-vs-host disease (GVHD) [abstract]. Blood 1997 Nov 15; 90 (Pt 2) Suppl. 1: 366
Yanik G, Levine JE, Nandwani S, et al. Graft versus host disease prophylaxis with tacrolimus dosed to achieve low serum levels: is it effective prophylaxis in pediatric patients receiving allogeneic marrow transplants [abstract]? Blood 1997 Nov 15; 90 (Pt 2) Suppl. 1: 377b
Reynolds C, Ratanatharathorn V, Adams P, et al. Comparative analysis of tacrolimus/methotrexate versus tacrolimus in allogeneic peripheral blood stem cell transplants: engraftment, GVHD, relapse, and survival outcomes [abstract]. Blood 1998 Nov 15; 92 (Pt 1) Suppl. 1: 449a
Uberti JP, Adams PT, Silver SM, et al. Allogeneic peripheral blood stem cell transplantation for high-risk hematologie ma-lignancies: the efficacy of tacrolimus for the prevention of acute graft-versus-host disease [abstract]. Blood 1997 Nov 15; 90 (Pt 2) Suppl. 1: 393
Przepiorka D, Petropoulos D, Mullen CA, et al. Tacrolimus for prevention of graft-versus-host disease after mismatched unrelated donor cord blood transplantation. Bone Marrow Transplant 1999 Jun; 23(12): 1291–5
Przepiorka D, Ippoliti C, Khouri I, et al. Impact of prophylaxis regimen on the incidence of acute graft-versus-host disease after allogeneic blood stem cell transplantation [abstract]. Bone Marrow Transplant 1998 Jun; 21 Suppl. 3: 107
Nasr F, Cleary K, Ippoliti C, et al. Tacrolimus and reduced dose methotrexate for prevention of GVHD after HLA-identical marrow or blood stem cell transplantation [abstract]. Blood 1998 Nov 15; 92 (Pt 1) Suppl. 1: 450a
Ratanatharathorn V, Nash RA, Przepiorka D, et al. Phase III study comparing methotrexate and tacrolimus (Prograf, FK506) with methotrexate and cyclosporine for graft-versus-host disease prophylaxis after HLA-identical sibling bone marrow transplantation. Blood 1998 Oct 1; 92: 2303–14
Nash RA, Antin J, Karanes C, et al. Phase HI study comparing tacrolimus with cyclosporine for prophylaxis of acute graft-versus-host disease after marrow transplantation from unrelated donors [abstract]. Blood 1997 Nov 15; 90 (Pt 1) Suppl. 1: 561
Hiraoka A, Japanese FK506 BMT Study Group. Results of a phase HI study on prophylactic use of FK506 for acute GVHD compared with cyclosporin in allogeneic bone marrow transplantation [abstract]. Blood 1997 Nov 15; 90 (Pt 1) Suppl. 1: 561a
Horowitz MM, Prezepiorka D, Bartels P, et al. Tacrolimus vs. cyclosporine immunosuppression: results in advanced-stage disease compared with historical controls treated exclusively with cyclosporine. Biol Blood Marrow Transplant 1999; 5: 180–6
FDA panel rejects tacrolimus for BMT. Scrip 1999 Jan 15(2403): 17
Furlong T, Storb R, Anasetti C, et al. Conversion to FK506 for cyclosporine (CSP)-resistant acute GVHD or CSP-associated toxicity [abstract]. Blood 1997 Nov 15; 90 (Pt 1) Suppl. 1: 104a–5a
Wolff D, Becker C, Kürschner D, et al. Treatment of graft-versus-host disease with FK 506 [abstract]. Br J Haematol 1998 Jul; 102(1): 210
Abd-Elghany W, Williams M, Lawson S, et al. FK506 (Tacrolimus) in treatment of steroid resistant graft versus host disease in children post bone marrow transplant [abstract]. Bone Marrow Transplant 1998 Mar; 21 Suppl. l: S120
Mookerjee B, Altomonte V, Vogelsang G. Salvage therapy for refractory chronic graft-versus-host disease with mycopheno-late mofetil and tacrolimus. Bone Marrow Transplant 1999; 24: 517–20
Henry ML. Cyclosporine and tacrolimus (FK506): a comparison of efficacy and safety profiles. Clin Transpl 1999 Jun; 13: 209–20
Williams R, Neuhaus P, Bismuth H, et al. Two-year data from the European multicentre tacrolimus (FK506) liver study. Transpl Int 1996; 9 Suppl. 1: S144–50
Böttiger Y, Brattström C, Tydén G, et al. Tacrolimus whole blood concentrations correlate closely to side-effects in renal transplant recipients. Br J Clin Pharmacol 1999 Sep; 48: 445–8
Jusko WJ, Thomson AW, Fung J, et al. Consensus document: therapeutic monitoring of tacrolimus (FK-506). Ther Drug Monit 1995; 17(6): 606–14
Busuttil RW, Klintmalm GB, Lake JR, et al. General guidelines for the use of tacrolimus in adult liver transplant patients [letter]. Transplantation 1996 Mar 15; 61: 845–7
Wingard JR, Nash RA, Przepiorka D, et al. Relationship of tacrolimus (FK506) whole blood concentrations and efficacy and safety after HLA-identical sibling bone marrow transplantation. Biol Blood Marrow Transplant 1998; 4: 157–63
Ratanatharathorn V, Antin J, Karanes C, et al. Relationship of tacrolimus and cyclosporine blood concentrations to the risk of acute GVHD and renal dysfunction after unrelated donor marrow transplantation [abstract]. Blood 1998 Nov 15; 92 (Pt 1) Suppl. 1: 449a
Shapiro R, Scantlebury VP, Jordan ML, et al. Reversibility of tacrolimus-induced posttransplant diabetes: an illustrative case and review of the literature. Transplant Proc 1997 Sep; 29: 2737–8
Jain A, McCauley J, Kashyap R, et al. Incidence of end-stage renal failure amongst long-term survival of primary liver transplant recipients under tacrolimus: adults and children [abstract]. Transplantation 1998 Jun 27; 65: S24
Grupp C, Schmidt F, Braun F, et al. Haemolytic uraemic syndrome (HUS) during treatment with cyclosporin A after renal transplantation: is tacrolimus the answer? Nephrol Dial Transplant 1998 Jul; 13: 1629–31
Franz M, Regele H, Schmaldienst S, et al. Posttransplant hemolytic uremic syndrome in adult retransplanted kidney graft recipients: advantage of FK506 therapy? Transplantation 1998 Nov 15; 66: 1258–62
Walder B, Ricou B, Suter PM. Tacrolimus (FK 506)-induced hemolytic uremic syndrome after heart transplantation. J Heart Lung Transplant 1998 Oct; 17: 1004–6
Schmidt RH, Lenz T, Gröne H-J, et al. Haemolytic-uraemic syndrome after tacrolimus rescue therapy for cortisone-resistant rejection. Nephrol Dial Transplant 1999 Apr; 14: 979–83
Humar A, Jessurun J, Sharp HL, et al. Hemolytic uremic syndrome in small-bowel transplant recipients: the first two case reports. Transpl Int 1999; 12(5): 387–90
Chang CWJ. Neurologic complications of critical illness and transplantation. Curr Opin Crit Care 1999 Apr; 5(2): 112–8
Mueller AR, Platz KP, Christe W, et al. Severe neurotoxicity after liver transplantation: association between FK 506 therapy and hepatitis C virus disease. Transplant Proc 1994 Dec; 26(6): 3131–2
Shapiro R, Scantlebury V, Jordon ML, et al. Posttransplant diabetes in pediatric recipients on tacrolimus [letter]. Transplantation 1999; 67: 771
Fishbein TM, Shapiro R, Jordan MD, et al. Resolution of hyperglycemia in pancreas transplant recipients treated with tacrolimus [abstract no. 228]. Transplantation 1998 Oct 27; 66(8): S57
Elmer DS, Abdulkarim AB, Fraga D, et al. Metabolic effects of FK 506 (tacrolimus) versus cyclosporine in portally drained pancreas allografts. Transplant Proc 1998 Mar; 30: 523–4
Loss M, Winkler M, Schneider A, et al. Glucose and lipid metabolism in liver transplant patients under long-term tacrolimus (FK 506) monotherapy. Transplant Proc 1996 Apr; 28: 1006–7
Friemann S, Feuring E, Padberg W, et al. Improvement of nephrotoxicity, hypertension, and lipid metabolism after conversion of kidney transplant recipients from cyclosporine to tacrolimus. Transplant Proc 1998 Jun; 30: 1240–2
Canzanello VJ, Schwartz L, Taler SJ, et al. Evolution of cardiovascular risk after liver transplantation: a comparison of cyclosporine A and tacrolimus (FK506). Liver Transpl Surg 1997 Jan; 3: 1–9
Ahsan N. Diabetes mellitus with Neoral (cyclosporine) vs Prograf (tacrolimus) based regimens after kidney transplant [abstract]. Transplantation 1998 Jun 27; 65: S91
Tanabe K, Tokumoto T, Ishikawa N, et al. De novo insulin-dependent diabetes mellitus in living kidney transplant recipients under tacrolimus immunosuppression [abstract]. 7th Alexis Carrel Conference 1998 Oct 20: Kyoto, 50
Guckelberger O, Bechstein WO, Neuhaus R, et al. Cardiovascular risk factors in long-term follow-up after orthotopic liver transplantation. Clin Transplant 1997 Feb; 11: 60–5
Canzanello VJ, Schwartz LL, Taler SJ, et al. Effect of conversion from cyclosporine A (CSA) to tacrolimus (FK506) on cardiovascular risk factors in liver transplant recipients [abstract]. Hepatology 1997 Oct; 26 (Pt 2) Suppl.: 489A
Burke GW, Ciancio G, Alejandro R, et al. Cholesterol control: long-term benefit of pancreas-kidney transplantation with FK506 immunosuppression. Transplant Proc 1998 Mar; 30: 513–4
McCune TR, Thacker II LR, Peters TG, et al. Effects of tacrolimus on hyperlipidemia after successful renal transplantation: a Southeastern Organ Procurement Foundation multi-center clinical study. Transplantation 1998 Jan 15; 65: 87–92
Claesson K, Mayer AD, Squifflet J-P, et al. Lipoprotein patterns in renal transplant patients: a comparison between FK 506 and cyclosporine A patients. Transplant Proc 1998 Jun; 30: 1292–4
Penson MG, Winter WE, Fricker FJ, et al. Tacrolimus-based triple-drug immunosuppression minimizes serum lipid elevations in pediatric cardiac transplant recipients. J Heart Lung Transplant 1999 Jul; 18: 707–13
Vela CG, Cristol JP, Descomps B, et al. Serum lipids and apolipoproteins in renal transplant recipients: a comparative study of cyclosporin A and FK 506 [abstract]. Nephrol Dial Transplant 1998 Jun; 13: A257
Aboulijoud MS, Levy MF, Klintmalm, et al. Hyperlipidemia after liver transplantation: long-term results of the FK506/cyclosporine a US multicenter trial. Transplant Proc 1995; 27(1): 1121–3
Charco R, Cantarell C, Vargas V, et al. Hypercholesterolemia in long-term survivors of liver transplantation: a comparison between cyclosporine and FK 506. Transplant Proc 1998 Jun; 30: 1489
Laws FA, Mathew M, Gupta PM, et al. The effect of cyclosporine versus Prograf on lipid metabolism after renal transplantation [abstract]. J Invest Med 1998 Mar; 46: 221A
Friemann S, Stopp K, Christ B, et al. Conversion to tacrolimus in hyperlipidemic patients. Transplant Proc 1999; 31 Suppl. 7A: 41S–3S
Manzarbeitia C, Reich D, Lamb C, et al. Tacrolimus conversion from Neoral improves hyperlipidemic states in stable liver transplant recipients [abstract]. Transplantation 1999 May 15; 67: S634
Niederstadt C, Steinhoff J, Erbslöh-Möller B, et al. Effect of FK506 on magnesium homeostasis after renal transplantation. Transplant Proc 1997 Nov; 29: 3161–2
Ligtenberg G, Hene RJ, Blankestijn PJ, et al. Tacrolimus (TAC) versus cyclosporin A (CsA): a favorable vascular risk profile in renal transplant recipients [abstract no. A3724]. Renal Week of the American Society of Nephrology; 1999 Nov 1–8; Miami Beach (FL)
Atkison P, Joubert G, Barron A, et al. Hypertrophic cardiomyopathy associated with tacrolimus in paediatric transplant patients. Lancet 1995 Apr 8; 345: 894–6
Scott JS, Boyle GJ, Daubeney PE, et al. Tacrolimus: a cause of hypertrophic cardiomyopathy in pediatric heart transplant recipients? Transplant Proc 1999 Feb–Mar; 31: 82–3
Somerville T, Reddy S, Alloway R, et al. Incidence and management of mycophenolate mofetil adverse effects in simul-taneous kidney/pancreas transplant recipients [abstract]. Transplantation 1998 Jun 27; 65: S137
Sokal EM, Antunes H, Beguin C, et al. Early signs and risk factors for the increased incidence of Epstein-Barr virus-re-lated posttransplant lymphoproliferative diseases in pediatric liver transplant recipients treated with tacrolimus. Transplantation 1997 Nov 27; 64: 1438–42
Shapiro R, Nalesnik M, McCauley J, et al. Post-transplant lymphoproliferative disorders (PTLD) in adult and pediatric renal transplant patients receiving tacrolimus-based immunosuppression [online]. Available from: URL: http://www.a-s-t.org [Accessed 2000 Jan 5]
So S, and the US Multicenter FK506 Liver Study Group. Post-transplant lymphoproliferative disorders (PTLD) in tacrolimus-treated liver transplant patients [abstract no. 207]. Proceedings of the 15th Annual Meeting of the American Society of Transplant Physicians; 1996 May 26–30, Dallas (TX): 136
McDiarmid SV. The use of tacrolimus in pediatric liver transplantation. J Pediatr Gastroenterol Nutr 1998 Jan; 26: 90–102
Cacciarelli TV, Jaffe R, Green M, et al. A decreasing incidence of posttransplant lymphoproliferative disorder (PTLD) in pediatric liver transplant recipients under primary tacrolimus (FK506) therapy [abstract no. 289]. Proceedings of the 16th Annual Meeting of the American Society of Transplant Physicians 1997; 157
Cacciarelli TV, Esquivel CO, Cox KL, et al. Oral tacrolimus (FK506) induction therapy in pediatric orthotopic liver transplantation. Transplantation 1996 Apr 27; 61: 1188–92
Newell KA, Alonso EM, Whitington PF, et al. Posttransplant lymphoproliferative disease in pediatric liver transplantation: interplay between primary Epstein-Barr virus infection and immunosuppression. Transplantation 1996 Aug 15; 62: 370–5
McDiarmid SV, Wallace P, Vargas J, et al. The treatment of intractable rejection with tacrolimus (FK506) in pediatric liver transplant recipients. J Pediatr Gastroenterol Nutr 1995 Apr; 20: 291–9
Alberti D, Reding R, Otte JB, et al. Conversion from tacrolimus to microemulsion formulation of cyclosporine in pediatric liver transplantation. Transplant Proc 1998 Aug; 30: 1858–60
Chang R-K, Alzona M, Alejos J, et al. Marked left ventricular hypertrophy in children on tacrolimus after orthotopic liver transplantation. Am J Cardiol 1998 May 15; 81: 1277–80
Moxey-Mims MM, Kay C, Light JA, et al. Increased incidence of insulin-dependent diabetes mellitus in pediatric renal transplant patients receiving tacrolimus (FK506). Transplantation 1998 Mar 15; 65: 617–9
Paolillo JA, Wagner K, Boyle GJ, et al. Post-transplant diabetes mellitus in pediatric thoracic organ recipients receiving tacrolimus-based immunosuppression [abstract]. Transplan-tation 1999 Apr 15; 67(7): S230
Armenti VT, Moritz MJ, Davison JM. Drug safety issues in pregnancy following transplantation and immunosuppression: effects and outcomes. Drug Saf 1998 Sep; 19: 219–32
Casele HL, Laifer SA. Association of pregnancy complications and choice of immunosuppressant in liver transplant patients. Transplantation 1998 Feb 27; 65: 581–3
Jain A, Venkataramanan R, Fung JJ, et al. Pregnancy after liver transplantation under tacrolimus [see comments]. Transplantation 1997 Aug 27; 64: 559–65
Armenti VT, Gaughan WJ, Dunn SR, et al. National transplantation pregnancy registry: pregnancy outcomes in female kidney recipients treated with cyclosporine microemulsion (Neoral) or tacrolimus vs. cyclosporine [abstract]. Transplantation 1998 Jun 27; 65: S77
Wu A, Nashan B, Messner U, et al. Outcome of 22 successful pregnancies after liver transplantation. Clin Transpl 1998 Oct; 12: 454–64
Rayes N, Neuhaus R, David M, et al. Pregnancies following liver transplantation —how safe are they? A report of 19 cases under cyclosporine A and tacrolimus. Clin Transpl 1998 Oct; 12: 396–400
Resch B, Mache CJ, Windhager T, et al. FK 506 and successful pregnancy in a patient after renal transplantation. Transplant Proc 1998 Feb; 30: 163–4
Midtvedt K, Hartmann A, Brekke IB, et al. Successful pregnancies in a combined pancreas and renal allograft recipient and in a renal graft recipient on tacrolimus treatment. Nephrol Dial Transplant 1997 Dec; 12: 2764–5
Vyas S, Kumar A, Piecuch S, et al. Outcome of twin pregnancy in a renal transplant recipient treated with tacrolimus. Transplantation 1999 Feb 15; 67: 490–2
Mignat C. Clinically significant drug interactions with new immunosuppressive agents. Drug Saf 1997 Apr; 16: 267–78
Zucker K, Rosen A, Tsaroucha A, et al. Augmentation of mycophenolate mofetil pharmacokinetics in renal transplant patients receiving Prograf and Cellcept in combination therapy [abstract]. Transplant Proc 1997 Feb–Mar; 29: 334–6
Venkataramanan R, Jain A, Hamad I, et al. Mycophenolate mofetil has no effect on tacrolimus pharmacokinetics in liver transplant patients [abstract]. Ther Drug Monit 1997 Oct; 19: 561
Undre NA, van HJ, Christiaans M, et al. Pharmacokinetics of FK 506 and mycophenolic acid after the administration of a FK 506-based regimen in combination with mycophenolate mofetil in kidney transplantation. Transplant Proc 1998 Jun; 30: 1299–302
Zucker K, Rosen A, Nichols A, et al. A definitive effect of administration of tacrolimus on the pharmacokinetics of mycophenolate mofetil in renal transplant patients [abstract]. Transplantation 1999 Apr 15; 67: S269
Smak Gregoor PJH, de Sévaux RGL, Hené RJ, et al. Effect of cyclosporine on mycophenolic acid trough levels in kidney transplant recipients. Transplantation 1999; 68(10): 1603–6
Hübner GI, Eismann R, Sziegoleit W. Drug interaction between mycophenolate mofetil and tacrolimus detectable within therapeutic mycophenolic acid monitoring in renal transplant recipients. Ther Drug Monit 1999; 21: 536–9
Bardsley-Elliot A, Noble S, Foster RH. Mycophenolate mofetil: a review of its use in the management of solid organ transplantation. BioDrugs 1999; 12(5): 363–410
van Gelder T, Klupp J, Barten M, et al. Coadministration of tacrolimus (FK) and mycophenolate mofetil (MMF) does not increase mycophenolic acid (MPA) exposure, but coadministration of cyclosporine (CsA) and MMF inhibits the enterohepatic recirculation of MPA, thereby decreasing its exposure [abstract no. A3622]. 32nd Annual Meeting and 1999 Renal Week of the American Society of Nephrology, 1999 Nov 1–8; Miami Beach (FL), J Am Soc Nephrol 1999; 10: A3622
Wingard JR, Nash RA, Ratanatharathorn V, et al. Lack of interaction between tacrolimus (FK506) and methotrexate in bone marrow transplant recipients. Bone Marrow Transplant 1997 Jul; 20: 49–51
Prograf (tacrolimus) prescribing information. London: Fujisawa Ltd, revised 17 Jul 1998
Garrity Jr ER, Hertz MI, Trulock EP, et al. Suggested guidelines for the use of tacrolimus in lung-transplant recipients. J Heart Lung Transplant 1999; 18: 175–6
Hutton J. The economics of immunosuppression in renal transplantation: a review of recent literature. Transplant Proc 1999 Feb–Mar;31: 1328–32
Dew MA, Switzer GE, Goycoolea JM, et al. Does transplantation produce quality of life benefits? A quantitative analysis of the literature. Transplantation 1997 Nov 15; 64: 1261–73
Shield III IC, McGrath MM, Goss TF, et al. Assessment of health-related quality of life in kidney transplant patients receiving tacrolimus (FK506)-based versus cyclosporine-based immunosuppression. Transplantation 1997 Dec 27;64: 1738–43
Morris-Stiff G, Richards T, Singh J, et al. Pharmaco-economic study of FK 506 (Prograf) and cyclosporine A Neoral in cadaveric renal transplantation. Transplant Proc 1998 Jun; 30: 1285–6
McAlister VC, Peltekian K, Bitter-Suermann H, et al. Cost of liver transplantation using tacrolimus. Transplant Proc 1998 Jun; 30: 1502
Neylan JF, Sullivan EM, Steinwald B, et al. Assessment of the frequency and costs of posttransplantation hospitalizations in patients receiving tacrolimus versus cyclosporine. Am J Kidney Dis 1998 Nov; 32: 770–7
Everson GT, Shrestha R, Trouillot T, et al. Costs of cyclosporine (Neoral) and tacrolimus (Prograf) in the first year after liver transplantation [abstract]. Transplantation 1998 Jun 27; 65: S51
Bachinger A, Kirchhoff D, Rychlik R. Immunosuppression with tacrolimus (FK 506) and cyclosporin A in prevention of rejection after liver transplantation: retrospective analysis of medical costs based upon the study FG-0157 [in German]. Chirurg 1998 Sep; 69: 957–62
Olivera D. Economic analysis of Prograf (tacrolimus) and cyclosporin in the prevention of kidney allograft rejection. N Horiz Kidney Transpl 1997; 1: 12–5
Lake JR, Gorman KJ, Esquivel CO, et al. The impact of immunosuppressive regimens on the cost of liver transplantation —results from the U.S. FK506 multicentertrial. Transplantation 1995 Nov 27; 60: 1089–95
McKenna M, Alexander G, Jones M, et al. Economic analysis of tacrolimus (FK506) and cyclosporin in prevention of liver allograft rejection. Eur Hosp Pharm 1996 Sep; 2(4): 181–8
Reimer J, Franke GH, Kohnle M, et al. Quality of life of end-stage renal disease patients after transplantation under different immunosuppressive therapies [abstract no. 34]. Qual Life Res 1999; 8(7): 565
Dew MA, Harris RC, Simmons RG, et al. Quality-of-life advantages of FK 506 vs conventional immunosuppressive drug therapy in cardiac transplantation. Transplant Proc 1991 Dec; 23: 3061–4
Denton MD, Magee CC, Sayegh MH. Immunosuppressive strategies in transplantation. Lancet 1999 Mar 27; 353: 1083–91
Keown PA. Therapeutic strategies for optimal use of novel immunosuppressants. Transplant Proc 1999 Jun; 31: 1790–2
Vanrenterghem Y. Vascular rejection with tacrolimus and potential long-term graft outcome. Transplant Proc 1999; 31 Suppl. 7A: 86S–7S
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Various sections of the manuscript reviewed by: P.R. Atkison, Paediatric Transplant Program, Children’s Hospital of Western Ontario, London, Ontario, Canada; O. Goulet, Department of Pediatric Gastroenterology and Nutrition, Hôpital Necker-Enfants Malades, Paris, France; R.W.G. Gruessner, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA; R. Hattori, Department of Urology, Okazaki City Hospital, Okazaki, Japan; M.L. Henry, Department of Surgery, Division of Transplantation, Ohio State University Medical Center, Columbus, Ohio, USA; A.B. Jain, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; S.C. Jensik, Rush University Transplant Program, Rush-Presbyterian-St Luke’s Medical Center, Chicago, Illinois, USA; H. Kreis, Assistance Publique Hôpitaux de Paris, Hôpital Necker, Paris, France; Ph. Lang, Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Créteil, France; R. Shapiro, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; N. Yoshimura, Second Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Data Selection
Sources: Medical literature published in any language since 1997 on tacrolimus, identified using AdisBase (a proprietary database of Adis International, Auckland, New Zealand) and Medline. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.
Search strategy: AdisBase search terms were ‘Tacrolimus’ or ‘FK-506’ or ‘FR-900506’ or ‘L-679934’ and ‘Transplant’ or ‘Transplant-Rejection’. Medline search terms were ‘Tacrolimus’ or ‘FK 506’ and ‘Transplantation’ or ‘Graft-Rejection’. Searches were last updated 27 January 2000.
Selection: Studies in patients with solid organ transplantation or bone marrow transplantation who received tacrolimus. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic, pharmacokinetic and pharmacoeconomic data are also included.
Index terms: Tacrolimus, immunosuppressant, transplantation, pharmacodynamics, pharmacokinetics, drug interactions, therapeutic use, tolerability, pharmacoeconomics.
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Plosker, G.L., Foster, R.H. Tacrolimus. Drugs 59, 323–389 (2000). https://doi.org/10.2165/00003495-200059020-00021
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DOI: https://doi.org/10.2165/00003495-200059020-00021