Table 4.
Dosing regimen for immunosuppression in pediatric lung transplantation (Hannover).
| Intraoperatively | |||
|---|---|---|---|
| Methylprednisolone | Prednisolone | MMF | Tacrolimus |
| 20 mg/kg (max. 1 g) iv | – | – | Start with continuous iv infusion: 0.02 mg/kg/d |
| Postoperatively, days 0–2 | |||
| Methylprednisolone | Prednisolone | MMF | Tacrolimus |
| 12 h post OP: 2 mg/kg iv 24 h post OP: 2 mg/kg iv 36 h post OP: 2 mg/kg iv |
– | 30 mg/kg/d | a |
| Postoperatively, from day 3 | |||
| Methylprednisolone | Prednisolone | MMF | Tacrolimus |
| – | d3–d5: 2 mg/kg/d d6–d9: 1 mg/kg/d d10–d28: 0.5 mg/kg/d mo 2: 0.35 mg/kg/d mo 3: 0.25 mg/kg/d mo 4: 0.2 mg/kg/d mo 7: 0.15 mg/kg/d mo 13: 0,1 mg/kg/d |
Target dose: 1,2 g/m2/d Target drug level: 1,2–3,5 mg/L |
Target drug levels: months 0–6: 12–15 µg/L months 7–12: 10–12 µg/L from month 13: 8–10 µg/L |
The standard immunosuppression in pediatric lung transplantation used in our center consisted of oral tacrolimus, mycophenolate-mofetil, and prednisolone. No induction is used in our center.
d, days postoperatively (day 0 = day of surgery); iv, intravenous; MMF, mycophenolate-mofetil; d, day; iv, intravenous.
Initially, the tacrolimus dose is increased very cautiously for nephroprotection. Accordingly, the tacrolimus serum level on postoperative day 2 is usually not in the primary target range of 12–15 µg/L. When continuous intravenous administration is switched to oral tacrolimus, the current cumulative intravenous daily dose is tripled for oral dosing in CF patients and doubled in non-CF patients. The cumulative daily oral dose (divided into two single doses) is then adjusted depending on blood levels.