Conversion to Prolonged-release Tacrolimus for Pediatric Living Related Donor Liver Transplant Recipients

Prolonged-release tacrolimus allows for once-daily dosing. Although many adult recipients have been switched from standard tacrolimus, prolonged-release tacrolimus has not been popular for pediatric patients despite the potential benefits for medication compliance. We report on prolonged-release tacrolimus for 11 pediatric living related donor liver transplant (LRDLT) recipients. Patients under 18 years of age who were receiving standard tacrolimus-based immunosuppression and steroid taper underwent conversion from standard to prolonged-release tacrolimus. We monitored tacrolimus trough levels and liver function tests (LFTs). We also assessed adverse effects and satisfaction levels for prolonged-release tacrolimus. Mean age at transplantation was 4.3 years. The mean duration of follow-up was 12 months. The ratios of trough levels with prolonged-release vs standard tacrolimus were 0.97, 0.95, and 0.92 at 1, 2, and 4 weeks post conversion, respectively. Two patients discontinued prolonged-release tacrolimus owing to abnormal LFTs and neurological abnormalities, respectively; but symptoms resolved after reconversion. One patient returned to standard tacrolimus and the other was converted to cyclosporine. Once-daily administration satisfied 89% of patients. In the overall assessment, conversion to prolonged-release tacrolimus satisfied all patients. Prolonged-release tacrolimus was useful for pediatric patients after LRDLT. Trough levels after conversion were compatible with those before conversion. Most patients were satisfied with prolonged-release tacrolimus. However, some patients failed conversion because of unexpected responses. Close observation after conversion is required even if patients have previously had an uneventful course on standard tacrolimus.