Conversion from twice-daily to once-daily Tacrolimus administration in liver transplant patient: results of long term follow-up.

OBJECTIVES: The aim of this study was to assess the long term effects of once-daily tacrolimus (OD-TAC) in a cohort of stable liver recipients converted from the twice daily tacrolimus (TD TAC), with a particular attention on the possible effects on renal function. PATIENTS AND METHODS: Between September 2008 and September 2010 conversion from TD-TAC to OD-TAC was proposed in adult stable liver transplant recipients who were followed as outpatients in our Transplant centre. Conversion from TC-TAC to OD-TAC was based on a 1 mg: 1 mg proportion. Tacrolimus through levels, laboratory parameters, metabolic disorders and any adverse events were evaluated at 1, 3, 6, 12 and 24 months after conversion. Renal function was evaluated using creatinine plasma levels and estimated glomerular filtration rate (GFR) derived from the Modification of Diet in Renal Disease (MDRD). Analysis of variance and t test for paired data were utilised for the comparison of the results obtained at the scheduled controls. RESULTS: Sixty-five patients were enrolled in the study (50 males, 15 females, mean age 59±8 years). Median time since liver transplant (LT) was 39 months (range: 6 to 83 months). All patients were followed for a minimum of 12 months. Ninety per cent of patients stabilized their blood levels within 45 days. Liver function, glucose and plasma lipids concentration and arterial blood pressure remained stable during the study. Renal function improved during the 24 months of follow-up. No adverse events or acute rejection episodes were recorded during the study. CONCLUSIONS: Considering the advantage on patient compliance, the equivalent efficacy and the adequate safety of OD-TAC formulation may represent a useful option in liver transplant patients, with a possible advantage on renal function.

Glucocorticoids in paediatric rheumatology.

Glucocorticoid (GC) drugs are the most potent anti-inflammatory agents available for the treatment of paediatric rheumatic diseases. These medications are used for the management of extra-articular features of systemic juvenile idiopathic arthritis and are the mainstay of therapy in children with juvenile systemic lupus erythematosus, juvenile dermatomyositis, and systemic vasculitis. The general objective of GC therapy is to limit the maximal dose and the exposure to the highest doses to what is needed to achieve disease control and, then, to gradually taper the dose until the minimum level sufficient to maintain disease quiescence over time is reached. High-dose intravenous 'pulse' methylprednisolone administration is sometimes chosen to treat the most severe or acute manifestations of systemic inflammatory diseases. The rationale that underlies this treatment modality is to achieve an immediate, profound anti-inflammatory effect and to lessen toxicity associated with long-term continuous therapy in moderate to high daily doses. Intra-articular corticosteroid (IAC) injection is a safe and rapidly effective treatment for synovitis in children with JIA. Triamcinolone hexacetonide is the optimal corticosteroid preparation. Local injection therapy is used most frequently to treat oligoarthritis, but the strategy of performing multiple IAC injections to induce disease remission, while simultaneously initiating therapy with second-line or biologic agents, has been proposed also for children with polyarticular JIA. Administration of GCs is associated with potentially deleterious adverse effects, some of which can be irreversible. This highlights the need of a judicious use of these medications and a careful monitoring of their toxicity.

Evidence for chestnut pollinosis in Paris.

The existence of chestnut pollinosis in Paris is not generally accepted in spite of the production of very large quantities of chestnut pollen in July. We carried out systematic skin-prick testing with chestnut pollen on 81 patients seen in the allergology department. The results were positive in 17 of the 47 patients presenting seasonal symptoms and in none of the 34 patients with perennial symptoms (chi 2 test = 12.91, P < 0.001). Eight of the 17 positive patients had sIgE levels above 300 IU/ml, 15 had a positive RAST and 14 had a positive nasal provocation test result. On the basis of these findings and the results of the clinical examination during the peak period of pollen emission, we diagnosed chestnut pollinosis in 11 patients. We draw our conclusions from the evidence of this form of pollinosis in the Paris region, together with the reasons why it is, as yet, rarely recognized.