To evaluate retrospectively our experience with the use of Tacrolimus (FK 506) as baseline in LDLT and its adverse effects. Fifty three adult patients with end-stage liver failure 49 cases were post HCV, 2 were post HBV&C one case were post HBV and one case were cryptogenic cirrhosis recievied liver transplantation using the right lobe of compatible living donor between August 2001 and January 2004 at Dar Al Fouad Hospital in Cairo .All were male except 2 females with age ranging from 34-63yrs. Tacrolimus (Prograft, Fujisawa, Belguim) was administered immediately following LDLT through a naso-gastric tube Standard FK dosage of 2x0.075mg/kg/d. A standard steroid taper regimen was used. Trough plasma conc. of FK 506 were determined by the immunoasay (MEIA test, Tacrolimus 2, Abbott) once a day starting 24 hs before dose then daily during first 3 weeks postoperatively and 1, 2 and 3 months. A linear regression analysis was performed to study the relationships between FK conc. and different blood parameters as well as GRBWR at time of FK toxicity (renal dysfunction or sever neuropschyciatric changes). Fifteen cases (28.3%) had FK toxicity 3cases with renal dysfunction need to adjust the FK dose and 12 cases (22.6%) had severe neuropschyciatric complications toxicity
Necessitating discontinuation of the drug and shifting to cyclospolrin +/_ cellcept. FK dose at which toxicity started ranging from 0.5-3.3mg mean 1.74+/-1.24, trough level range 2-17ng with mean 9.33+/-4.4868 .The onset of FK toxicity ranging from 3 to 30 days with a mean of 11.266+/- 8.6059. There is a significant relationship between FK trough level at which toxicity started and s. amylase, Hb and GGT values but not with GRBW and urea level. The first week is having the highest incidence rate of FK toxicity in our experience. Recommendations: Reduced dose of of FK 506 in the first week to avoid unexpected FK- related toxicity.