Figure 1621

The experience at Children's Hospital of Pittsburgh using tacrolimus has been that 14% of 43 pediatric patients managed with tacrolimus for a mean period of 25 months developed posttransplantation lymphoproliferative disease (PTLD). This occurrence is very high compared with PTLD reported by the North American Pediatric Renal Transplant Cooperative Study in only six of 1550 (0.39% or 0.10%/y) children managed with various cyclosporine regimens [16]. Epstein-Barr virus (EBV) has a primary role in the development of PTLD, and an even higher rate of EBV-related PTLD has been reported in children receiving tacrolimus for liver transplantation or rescue [17,18]. Children seem to have a greater predisposition to PTLD than do adults. Therefore, children need closer monitoring for this disorder when being managed with tacrolimus. The major advantages of tacrolimus over cyclosporine are a reduced severity of hypertension and an improved cosmetic appearance that, in turn, may improve patient compliance with medications. (From Ellis [19]; with permission.)

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