FIGURE 1.

Immunosuppression, kidney function, and peripheral blood WBC/lymphocyte/eosinophile counts are summarized for patients 1–5 (A–E). Tacrolimus dose was adjusted in individual patients to achieve target serum trough levels. The frequency of acute rejection episodes was 3 (patient 1), 1 (patient 2), 3 (patient 3), 1 (patient 4), and 1 (patient 5) (A–E). Patients received bolus steroids in the event of high-grade acute rejection that was nonresponsive to topical therapy. Rejection episodes resolved in all cases without requirement for a second maintenance immunosuppressive drug. In contrast to previous reports (1), no steroid-resistant episodes of acute rejection were observed with this regimen. All 5 patients are currently being maintained on tacrolimus monotherapy. Trough levels range between 4 and 6 ng/mL in patient 1 (A), 8 and 10 ng/mL in patient 2 (B) and patient 3 (C), and 10 and 12 ng/mL in patient 4 (D) and patient 5 (E). Side effects included transient increases in serum creatinine and hyperglycemia after transplant that initially required insulin but was then managed with glipizide 5 mg BID (patient 2, B), and a deep-vein thrombosis in the left lower extremity requiring coumadin treatment as well as a single episode of hyperuricemia that was treated with colchicine (patient 3, C). Patients 1 and 2 (A and B, respectively) required isoniazid prophylaxis with 300 mg QD after incidental and unanticipated exposure to a tuberculous patient while in the hospital.