Oral tacrolimus may improve graft survival in pediatric PKP patients
JAN 24, 2023
Cornea/External Disease, Pediatric Ophth/Strabismus
For children with anterior segment dysgenesis, the use of oral tacrolimus immunosuppression after penetrating keratoplasty (PKP) may improve graft survival rate in the first postoperative year. Longer-term graft survival remains poor.
This is a retrospective study of 14 children (20 eyes) undergoing penetrating keratoplasty (PKP) at a single tertiary children’s hospital in Birmingham, UK, between 2005 and 2016. Oral tacrolimus immunosuppression was replaced by topical tacrolimus (0.03%) after 2 years.
Of the 19 eyes with primary PKP, the rejection-free survival rate after 1 year for children with anterior segment dysgenesis (ASD) was 80% (n = 15) versus 100% for children who had non-ASD PKP (n = 4). At final review, 10 of 15 ASD PKPs failed after a mean of 19 months (2 due to infection, 2 to rejection, and 2 to glaucoma).
This is a small retrospective review with no control population. Systemic tacrolimus in a small child requires careful monitoring. Switching to topical tacrolimus after two years of systemic tacrolimus does not provide similar levels of immunosuppression.
Pediatric PKPs historically have a high risk of failure and rejection. Graft survival on systemic tacrolimus has not been well-characterized previously, but the reported 1-year graft survival rate on systemic tacrolimus in this small series is higher than historically reported in other small case series. Oral tacrolimus seems to be well-tolerated in this population and does not appear to have negative effects.
Financial disclosures: Dr. Gerami Seitzman discloses a financial relationship with Dompe (Consultant/Advisor).