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Use of prostaglandin E1 in crossmatch-negative liver transplant recipients treated with FK 506.

Although the overall strategy for the use of FK 506 remains the same as when this T-cell-directed drug was introduced clinically in 1989,1,2 there have been modifications. As with cyclosporine (CyA), the nephrotoxicity of FK 506 imposes a dose ceiling, necessitating its use in drug cocktails that include adrenal corticosteroids. We recently reported that liver transplant recipients with the immunological disadvantage of a positive cytotoxic crossmatch with their donors3 could have their prognosis converted to that in crossmatch-negative cases when FK 506 was combined with high induction doses of prednisone.4 A subgroup of these patients who also were treated perioperatively with prostaglandin E1 (PGE1) had superior renal function, suggesting an amelioration of nephrotoxicity by PGE1 without a loss of immunosuppression, or conceivably with a gain. In the trial reported here, PGE1 was evaluated in crossmatch-negative liver recipients.