Conversion to Prolonged Release Tacrolimus for Pediatric Living Related Donor Liver Transplantation

Abstract

Introduction: Prolonged release tacrolimus is once daily dose immunosuppression. Tacrolimus prolonged release is commercially available now. It is widely used for conversion from standard Tacrolimus in adults. However prolonged release tacrolimus is not popular for pediatric patients so far. Immunosuppression can be withdrawn in some pediatric patients after living related liver transplantation. Majority of the pediatric patients need immunosuppression for life long. Once daily administration is beneficial for pediatric patients too in the situation that patients keep on immunosuppression because of drug compliance. We will report prolonged release tacrolimus formula for pediatric living related donor liver transplantation. Methods: Patients had living related liver transplantation in our institution were involved in this study. Patients received standard tacrolimus based immunosuppression and steroid tapering in our protocol. Patients under 18 year olds at the time of conversion were eligible for this study. 11 patients received prolonged release tacrolimus as a conversion from standard Tacrolimus. Tacrolimus trough level and liver function test were collected at prior to conversion, and one week, 2 weeks and 4weeks after conversion. Adverse effect of prolonged release tacrolimus and satisfaction of patients and their parents were assessed. Results: Mean age at transplantation was 4.3 year olds (ranged 1.1 to 8.2 year olds). Mean age at conversion was 11.3year old (ranged 6.9 to 8.2 year old). Follow up period after conversion was mean 12 months (ranged 2.4 to 20.4 months). The original diseases were biliary atresia (n=9), Wilson's disease (n=1) and ornithine transcarbamylase deficiency (n=1). Tacrolimus trough level ratios comparing to standard Tacrolimus trough level were 0.97, 0.95 and 0.91 at 1, 2, 4 weeks after conversion respectively. Two patients aborted prolonged-release tacrolimus use because of abnormal liver function test and neurological abnormality. One patient returned to standard Tacrolimus and the other converted to cyclosporine. The symptoms were disappeared after reconversion. Patient satisfaction was surveyed except for patients who stop prolonged release tacrolimus. Once daily administration satisfied 86% of patients. Capsule type drug satisfied 86% patients although patients needed training to swallow a capsule in younger age. Conversion to prolonged release tacrolimus satisfied all patients in overall assessment. Conclusion: Prolonged release tacrolimus were useful for pediatric patients after living related liver transplantation. Patients older than 6 year olds can take capsule of the medication. Trough levels after conversion were compatible with those before conversion. Patients satisfied prolonged release. tacrolimus However some patients failed conversion because of unexpected response. Close observation after conversion were required even if patients take standard tacrolimus uneventfully.