Tacrolimus immunosuppression safe in kids with penetrating keratoplasty

Among children with penetrating keratoplasty, using oral tacrolimus for postoperative immunosuppression is safe, with encouraging rates of rejection-free survival and overall graft survival, a recent study has found.

Researchers conducted a retrospective cohort study of 14 children contributing a total of 20 eyes. In total, 24 PKs were up for analysis, 19 of which had primary PK, while five had repeat episodes. Patients were on oral tacrolimus for 2 years, after which treatment was switched to topical tacrolimus.

After 41 months of follow-up, 50 percent of all grafts were still functioning. At the final review, the 1-year survival rate was 73 percent, which dropped to 67 percent by 2 years. One graft survived to beyond 5 years.

In contrast, 62.5 percent of grafts failed overall, including both primary and secondary grafts. Majority (33 percent) of failure cases could be attributed to infections, including three cases of infective keratitis leading to evisceration. Two grafts failed due to glaucoma.

In terms of safety, researchers reported none of the previously documented adverse events such as nephropathy, neurotoxicity, and hepatotoxicity. There were also no episodes of immunosuppression-related illness. Infections rates were also comparable with literature figures, though severe infections tended to be more common in the present study.

“Moving forward, the challenge in paediatric graft survival will be to overcome the hurdles of infection and corneal graft vascularisation and aim to improve the survival of repeat grafts, as even a successful primary graft is unlikely to last the lifetime of the child,” the researchers said.