Oral tacrolimus may improve graft survival in pediatric PKP patients

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.

Study design

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.

Outcomes

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).

Limitations

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.

Clinical significance

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).