Massive Ingestion of Tacrolimus in a Young Liver Transplant Patient

ACROLIMUS (FK 506) is a macrolide antibiotic derived from the fungus Streptomyces tsukubaensis .I n vitro studies have shown that its immunosuppressive potency is 50 to 100 times higher than that of cyclosporine (CsA). This new drug (Prograf) opened up very interesting prospects in the prevention and curative treatment of acute or chronic steroid-resistant rejection occurring after transplantation of solid organs. Tacrolimus is usually well tolerated. The side effects are similar to those of CsA (nephrotoxicity, hypertension, neurotoxicity, diabetes) but less frequent. 1 Tacrolimus induces less hypertension than CsA, which permits reduction of antihypertensive treatments. In view of the higher incidence of hypertension in young transplant subjects, tacrolimus has an advantage over ciclosporine in this population. 2 The dosage for adults is between 0.1 and 0.3 mg/kg/d, taken in two separate doses. The doses required to obtain blood concentrations between 5 and 15 ng/mL are usually higher in children than in adults. We report a case of accidental intoxication by tacrolimus in a young infant having undergone liver transplant. There was a favourable outcome in spite of the high amount ingested.