Skip to main content
SpringerLink
Log in

FK506 in pediatric kidney transplantation—Primary and rescue experience

  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Between 14 December 1989 and 17 December 1993, 43 patients undergoing kidney transplantation alone at the Children's Hospital of Pittsburgh received FK506 as the primary immunosuppressive agent. The mean recipient age was 10.2±4.8 years (range 0.7–17.4 years), with 7 (16%) children under 5 years of age and 2 (5%) under 2 years of age. Fifteen (35%) children underwent retransplantation, and 5 (12%) had a panel-reactive antibody level greater than 40%. Twenty-two (51%) transplants were with cadaveric donors and 21 (49%) were with living donors. The mean follow-up was 25±14 months; there were no deaths; 1- and 3-year actuarial graft survival was 98% and 85%. The mean serum creatinine and blood urea nitrogen were 1.2±0.6 mg/dl and 26±11 mg/dl; the calculated creatinine clearance was 75±23 ml/min per 1.73 m2. Twenty-four (62%) patients have been successfully with-drawn from steroids and 24 (62%) require no anti-hypertensive medication. Improved growth was seen, particularly in pre-adolescent children off steroids. Between 28 July 1990 and 2 December 1993, 24 children were referred for rescue therapy with FK506, 14.6±16.4 months (range 1.1–53.2 months) after transplantation. Nineteen (79%) were referred because of resistant rejection; 4 (17%) were referred because of proteinuria; 1 (4%) was switched because of steroid-related obesity. There were no deaths; 1-and 2-year graft survival was 75% and 68%; 17 (71%) patients were successfully rescued, including 1 of 2 patients who arrived on dialysis; 4 (24%) of the successfully rescued patients were weaned off steroids. While not without side effects, which include nephrotoxicity, neurotoxicity, diabetogenicity, and viral complications, FK506 appears to be an effective immunosuppressive agent for both primary and rescue therapy after kidney transplantation. Its steroid-sparing qualities may be of particular importance in the pediatric population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. First International Workshop on “FK506 (1987) A potential breakthrough in immunosuppression”. Transplant Proc 19 [Suppl 6]: 3–103

    Google Scholar 

  2. Armitage JM, Kornos RL, Fung JJ, Starzl TE (1991) The clinical trial of FK506 as a primary and rescue immunosuppression in adult cadaveric transplantation. Transplant Proc 23:3054–3057

    PubMed  CAS  Google Scholar 

  3. Griffith BO, Bando K, Hardesty RL, Armitage JM, Keenan RJ, Paradis IL, Fung JJ, Starzl TE (1994) Prospective randomized trial of FK506 vs. cyclosporine after human pulmonary transplantation. Transplantation 57:848–851

    Article  PubMed  CAS  Google Scholar 

  4. Fung JJ, Abu-Elmagd K, Jain A, Gordon R, Tzakis A, Takaya S, Allessiani M, Demetris A, Bronsther O, Martin M, Mieles L, Selby R, Doyle H, Stieber A, Casavilla A, Starzl TE (1991) A randomized trial of primary liver transplantation under immunosuppression with FK506 vs. cyclosporine. Transplant Proc 23:2977–2983

    PubMed  CAS  Google Scholar 

  5. Starzl TE, Fung JJ, Jordan M, Shapiro R, Tzakis A, McCauley J, Johnston J, Iwaki Y, Jain A, Alessiani M, Todo S (1990) Kidney transplantation under FK506. JAMA 264:63–67

    Article  PubMed  CAS  Google Scholar 

  6. Todo S, Fung JJ, Starzl TE, Tzakis A, Demetris AJ, Kormos R, Jain A, Allessiani M, Takaya S, Shapiro R (1990) Liver, kidney and thoracic organ transplantation under FK506. Ann Surg 212:295–305

    Article  PubMed  CAS  Google Scholar 

  7. Shapiro R, Jordan M, Fung JJ, McCauley J, Johnston J, Iwaki Y, Tzakis A, Hakala T, Todo S, Starzl TE (1991) Kidney transplantation under FK506 immunosuppression. Transplant Proc 23:920–923

    PubMed  CAS  Google Scholar 

  8. Shapiro R, Jordan M, Scantlebury V, Fung JJ, Jensen C, Vivas C, McCauley J, Irish WD, Mitchell S, Demetris AJ, Randhawa P, Jain A, Tzakis A, Hakala TR, Simmons RL, Starzl TE (1993) Randomized trial of FK506/prednisone vs. FK506/azathioprine/prednisone after renal transplantation: preliminary report. Transplant Proc 25:669–672

    PubMed  CAS  Google Scholar 

  9. Shapiro R, Jordan M, Scantlebury V, Vivas C, Fung JJ, McCauley J, Tzakis A, Randhawa P, Demetris AJ, Irish W, Mitchell S, Jensen C, Jain A, Hakala T, Simmons R, Starzl TE (1995) A prospective, randomized trial of FK506 in renal transplantation—a comparison between double and triple drug therapy. Clin Transplant (in press)

  10. Todo S, Tzakis A, Reyes J, Abu-Elmagd K, Casavilla A, Nour BM, Selby R, Fung JJ, Van Thiel D, Starzl TE (1991) Clinical small bowel or small bowel plus liver transplantation under FK506. Transplant Proc 23:3093–3098

    PubMed  CAS  Google Scholar 

  11. Ricordi C, Tzakis A, Carroll P, Zeng Y, Rilo HLR, Alejandro R, Shapiro R, Fung JJ, Mintz DH, Starzl TE (1991) Human islet allotransplantation under FK506. Transplant Proc 23:3207

    PubMed  CAS  Google Scholar 

  12. Jensen C, Jordan M, Schneck F, Shapiro R, Tzakis A, Hakala T, Starzl TE (1991) Pediatric renal transplantation under FK506 immunosuppression. Transplant Proc 23:3075–3077

    PubMed  CAS  Google Scholar 

  13. Schneck F, Jordan M, Jensen C, Shapiro R, Tzakis A, Scantlebury V, Ellis D, Gilboa N, Simmons R, Hakala T, Starzl TE (1992) Pediatric renal transplantation under FK506 immunosuppression. J Urol 147:1585–1587

    PubMed  CAS  Google Scholar 

  14. Ellis D, Shapiro R, Jordan ML, Scantlebury VP, Gilboa N, Hopp L, Weichler N, Simmons RL (1995) Comparison of FK506 and cyclosporine regimens in pediatric renal transplantation. Pediatr Nephrol (in press)

  15. Scantlebury V, Shapiro R, Tzakis A, Jordan M, Vivas C, Ellis D, Gilboa N, Hopp L, Irish W, Mitchell S, Hakala TR, Simmons RL, Starzl TE (1994) Pediatric kidney transplantation at the University of Pittsburgh. Transplant Proc 26:46–47

    PubMed  CAS  Google Scholar 

  16. Shapiro R, Tzakis A, Scantlebury V, Jordan M, Vivas C, Ellis D, Gilboa N, Irish W, Hopp L, Reyes J, Hakala T, Simmons RL, Starzl TE (1995) Improving results of pediatric kidney transplantation. J Am Coll Surg (in press)

  17. Jordan ML, Shapiro R, Jensen C, Scantlebury V, Fung J, Tzakis A, McCauley J, Jain A, Demetris, A., Randhawa P, Simmons RL, Hakala TR, Starzl TE (1991) FK506 conversion of renal allografts failing cyclosporine immunosuppression. Transplant Proc 23:3078–3081

    PubMed  CAS  Google Scholar 

  18. Jordan M, Shapiro R, Vivas C, Scantlebury V, Randhawa P, Carrieri G, McCauley J, Demetris AJ, Tzakis A, Fung JJ, Simmons RL, Hakala TR, Starzl TE (1995) FK506 rescue for resistant rejection of renal allografts under primary cyclosporine immunosuppression. Transplantation (in press)

  19. McCauley J, Shapiro R, Jordan M, Scantlebury V, Vivas C, Jensen C, Starzl TE (1993) FK506 in the management of nephrotic syndrome after renal transplantation. Transplant Proc 25:1351–1354

    PubMed  CAS  Google Scholar 

  20. Schwartz GJ, Gauthier B (1985) A simple estimate of glomerular filtration rate in adolescent boys. J Pediatr 106:522–526

    Article  PubMed  CAS  Google Scholar 

  21. McCauley J, Takaya S, Fung J, Tzakis A, Abu-Elmagd K, Jain A, Todo S, Starzl TE (1991) The question of FK506 nephrotoxicity after liver transplantation. Transplant Proc 23:1444–1447

    PubMed  CAS  Google Scholar 

  22. Starzl TE, Abu-Elmagd K, Tzakis A, Fung JJ, Porter KA, Todo S (1991) Selected topics on FK506, with special references to rescue of extrahepatic whole organ grafts, transplantation of “forbidden organs”, side effects, mechanisms, and practical pharmacokinetics. Transplant Proc 23:914–919

    PubMed  CAS  Google Scholar 

  23. Starzl TE (1993) FK506 versus cyclosporine. Transplant Proc 25:511–512

    PubMed  CAS  Google Scholar 

  24. Demetris AJ, Banner B, Fung J, Shapiro R, Jordan M, Starzl TE (1991) Histopathology of human renal allograft rejection under FK506: a comparison with cyclosporine. Transplant Proc 23:944–946

    PubMed  CAS  Google Scholar 

  25. Randhawa PS, Shapiro R, Jordan M, Starzl TE, Demetris AJ (1993) The histopathological changes associated with allograft rejection and drug toxicity in renal transplant recipients maintained on FK506: clinical significance and comparison with cyclosporine. Am J Surg Pathol 17:60–68

    Article  PubMed  CAS  Google Scholar 

  26. Sollinger HW, Deierhoi MH, Belzer FO, Diethelm AG, Kauffmann RS (1992) RS-61443—a phase I clinical trial and pilot rescue study. Transplantation 53:428–432

    Article  PubMed  CAS  Google Scholar 

  27. Makowka L, Chapman F, Cramer DV (1993) Historical development of Brequinar sodium as a new immunosuppressive drug for transplantation. Transplant Proc 25:2–7

    PubMed  CAS  Google Scholar 

  28. Morris RE (1991) Rapamycin: FK506's fraternal twin or distant cousin? Immunol Today 12:137–140

    PubMed  CAS  Google Scholar 

  29. Chong AS-F, Gebel H, Finnegan A, Petraitis EE, Jiang XL, Sankary HN, Foster P, Williams JW (1993) Leflunomide, a novel immunomodulatory agent: in vitro analyses of the mechanism of immunosuppression. Transplant Proc 25:747–749

    PubMed  CAS  Google Scholar 

  30. Morris RE (1991) ± 15-Deoxyspergualin: a mystery wrapped within an enigma. Clin Transplant 5:530–533

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pittsburgh Transplantation Institute, Department of Surgery, University of Pittsburgh Health Science Center of Pittsburgh, 3601 Fifth Avenue, 4th Floor Falk Clinie, 15213, Pittsburgh, PA, USA

    Ron Shapiro, Velma P. Scantlebury, Mark L. Jordan, Carlos Vivas, Andreas G. Tzakis, Demetrius Ellis, Nisan Gilboa, Laszlo Hopp, Jerry McCauley, William Irish, Sandi Mitchell, Thomas R. Hakala, Richard L. Simmons & Thomas E. Starzl

Authors
  1. Ron Shapiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Velma P. Scantlebury
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark L. Jordan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlos Vivas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas G. Tzakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Demetrius Ellis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nisan Gilboa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Laszlo Hopp
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jerry McCauley
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. William Irish
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sandi Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Thomas R. Hakala
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Richard L. Simmons
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Thomas E. Starzl
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shapiro, R., Scantlebury, V.P., Jordan, M.L. et al. FK506 in pediatric kidney transplantation—Primary and rescue experience. Pediatr Nephrol 9 (Suppl 1), S43–S48 (1995). https://doi.org/10.1007/BF00867683

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00867683

Key words

Search

Navigation