부산대학교 도서관

Purpose: This study reveals our experience with allergic symptoms in pediatric liver transplant recipients receiving primary tacrolimus (FK 506) based immunosuppression. Methods: We reviewed the charts of all patients receiving tacrolimus based immunosuppression, noting cases of severe food allergies. Patients experiencing allergies were studied for age at transplant and initiation of tacrolimus therapy, onset and type of symptoms, treatment received for allergies, resolution or persistence of allergies, and survival. Results: Between April 1991 and October 1998, 64 pediatric liver transplant recipients (48 primary, 16 conversion) received tacrolimus based immunosuppression. Patients receiving primary tacrolimus therapy received initial dose of 0.15 mg/kg/dose PO/NG q12hr. For patients converted from cyclosporine to tacrolimus, mean time until conversion was 10.5 mos. Serum tacrolimus trough levels were maintained between 7 and 10 ng/ml. Concomitant immunosuppression included methylprednisone and mycophenolate mofetil. Of these 64 patients, 11 (17%) experienced food allergies. For the 11 patients who experienced allergies, age at time of transplant ranged from 3 mos. to 2 yrs. (mean=13.4 mos.), whereas mean age for 53 patients who did not experience allergies was 46.5 mos. Mean time period between transplant and onset of allergies was 6 mos. Of the eleven patients who experienced allergies, the most common allergens were milk products (82%), eggs (64%), nuts (55%), fish (36%), wheat (27%), potatoes (27%), and soy (18%). At the time of transplant, all patients were receiving pregestamil, four of eleven (36%) patients were receiving total parenteral nutrition (TPN) and two (18%) had solid foods incorporated into diets. The most common symptoms of the allergic reactions were eczema, severe rashes, facial swelling congestion, wheezing, vomiting, diarrhea, and itching. Treatment of the allergic symptoms consisted of oral benadryl, hydrocortisone, nasalcrom, modification of diet (switch to alimentum or neocate), and epinephrine pins for emergencies. Furthermore, 6 of 11 patients received oral diphenhydramine and intramuscular dexamethasone. Four of eleven patients (36%) have resolved allergies and 6 of 11 (55%) have resumed normal diets. All patients are alive at 18 mos. to 7 years post transplant, and all patients currently receive tacrolimus. Conclusions: We conclude that allergies secondary to tacrolimus immunosuppression in this group of pediatric liver transplant recipients is a noteworthy and legitimate concern. We further speculate that such problems are encountered primarily by younger patients who have yet to be exposed to a wide array of antigens.
K. Prabhakaran, B.A., H.T. Lau, M.D., B. Wise, R.N., Ph.D., K. Schwarz, M.D., P.M. Colombani, M.D., FAAP; Divisions of Pediatric Surgery and Pediatric Gastroenterology, The Johns Hopkins University School of [...]