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Prolonged tacrolimus for pediatric gastrointestinal disorder: Double‐edged sword?
Author(s) -
Hosoi Kenji,
Arai Katsuhiro,
Matsuoka Kentaro,
Shimizu Hirotaka,
Kamei Koichi,
Nakazawa Atsuko,
Shimizu Toshiaki,
Tang Julian,
Ito Shuichi
Publication year - 2017
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13211
Subject(s) - medicine , sword , tacrolimus , gastroenterology , world wide web , transplantation , computer science
Background Although tacrolimus ( TAC ) can induce remission in children with refractory inflammatory bowel disease ( IBD ) or autoimmune gastroenteropathy ( AGE ), its use in maintenance therapy remains controversial. The aim of this study was to investigate the potential nephrotoxic nature of prolonged TAC use. Methods This retrospective study reviewed children with gastrointestinal disorder who underwent kidney biopsy for the evaluation of renal damage during TAC therapy for >1 year. The clinical and histological features of renal damage were evaluated in this single‐institution cohort. Results Eighteen of 121 children with IBD and two children with AGE followed at a national children hospital in Tokyo, Japan, received TAC between August 2006 and April 2013. Among them, five (Crohn's disease, n = 3; autoimmune gastropathy, n = 1; autoimmune enteropathy, n = 1) received TAC for >1 year, and underwent kidney biopsy. All five had achieved remission on TAC , but had histological evidence of chronic nephrotoxicity. Renal damage in one patient with relatively low TAC trough level remained mild. Estimated glomerular filtration rate ( eGFR ) at the time of kidney biopsy was lower than at the initiation of TAC in all four available patients. Among them, eGFR improved in one patient after the decrease or discontinuation of TAC. Conclusions TAC appeared to be effective in children with refractory gastrointestinal disorder, but long‐term use seems to cause irreversible renal damage. Rigorous monitoring of eGFR and kidney biopsy in selected cases should be considered for the proper adjustment of TAC .