FK 506 conversion of renal allografts failing cyclosporine immunosuppression.

Abstract

The use of cyclosporine (CyA) has resulted in significantly improved graft survival rates in renal transplantation. 1–5 However, the incidence of allograft rejection with CyA remains as high as 69%.5 Although CyA monotherapy has proven feasible in some studies,6 recent attempts to use CyA alone in kidney transplant recipients have shown some significant disadvantages, namely increased severity of rejection episodes and more pronounced nephrotoxicity.5 FK 506 is an experimental immunosuppressant that has yielded encouraging results in early trials of liver, heart, and, more recently, renal transplantation. 7–11 The apparent advantages of FK 506 in these early experiences include the ability to taper steroids aggressively to the point of permitting FK 506 monotherapy in as many as 60% of renal transplant recipients with no increased risk of rejection episodes.11 FK 506 has also been used successfully to salvage liver transplants rejecting under CyA immunosuppression.12 We have recently begun evaluating the utility of FK 506 conversion in renal allograft recipients with failing grafts on CyA. A total of 35 patients were entered into this pilot study, the results of which are reported herein.