Advagraf - Once daily therapy of tacrolimus is a promising alternative to the twice daily therapy of tacrolimus after pediatric heart transplantation

Introduction: The lifelong immunosuppressive therapy after pediatric heart transplantation can reduce the quality of life, on the one hand because of the side effects, on the other hand because of the limited lifestyle flexibility. Additionally the strict standards for the intake of the immunosuppressive therapy can cause a reduction of the compliance, especially in adolescence. Treatment with once daily therapy of tacrolimus could reduce these problems. Whether once daily therapy of tacrolimus is also a good alternative for pediatric patients is unknown yet.

Methods: Retrospective analysis of our patients under once daily therapy of tacrolimus since May 2012.

Results: Since May 2012 the immunosuppressive medication of 29 patients (42% of our patients) was switched from tacrolimus twice daily to tacrolimus once daily. The average age at time of change was 14 years (range 5 - 27 years). The average interval between heart transplantation and conversion of the medication was 6.7 years (range 2 months to 19 years). The conversion from tacrolimus twice daily to tacrolimus once daily was on a 1 : 1 mg basis. The levels of tacrolimus were stable after the conversion. None of the patients showed side effects after the change of the medication. Additionally there was no rejection.

Conclusions: Tacrolimus once daily is a save alternative also after pediatric heart transplantation. Already shortly after transplantation a therapy with tacrolimus once daily is possible.