FK 506 versus cyclosporine in pediatric liver transplantation.

Abstract

No group of patients is likely to benefit more by improvements in immunosuppression than the pediatric transplant recipients who face life-long treatment. The advent of cyclosporine (CyA) has transformed liver transplantation into the preferred treatment modality for chronic liver failure.1 Its effect on pediatric liver transplantation was profound, allowing for acceptable patient and graft survival when used with steroids at a fraction of the dose necessary under previous immunosuppressive regimens.2–8 Complications included renal toxicity, hypertension, gum hyperplasia, hirsutism, and an uncommon but very troubling syndrome of facial disfigurement. FK 506, a new immunosuppressive agent derived from Streptomyces tsukubaensis, was first shown to be efficacious in experimental9 and clinical primary liver transplantation,10–12 and also in reversing rejection in patients who failed CyA treatment.13 Additional indications for use in pediatrics were its apparent simplicity of use, low toxicity, and independence from adjuvant steroid therapy.9–14 This report summarizes our clinical experience with FK 506 from a prospective study of children who underwent primary liver transplantation at the Children's Hospital of Pittsburgh between October 1989 and October 1990. Follow-up is provided up to April 1991.