Removal of FK 506 by continuous hemofiltration: Report of two allograft recipients with renal and liver failures

We report the cases of 2 organ allograft recipients whose abnormally high FK 506 plasma levels were successfully reduced by continuous hemofiltration. The 1st patient, a renal allograft recipient, developed post-transplantation lymphoproliferative disease, liver failure and anuric renal failure during FK 506 rescue therapy. The 2nd patient, the recipient of a bilateral lung and heart allograft, developed multiorgan failure following repeated episodes of therapy-resistant hypotension. The plasma FK 506 concentrations in both patients remained elevated despite cessation of the drug for several days. In the first patient the FK 506 plasma concentration remained high despite 4 d of hemodialysis. During continuous hemofiltration of the 1st patient and continuous hemodiafiltration of the 2nd patient, the half-life of FK 506 in the plasma decreased by a factor of 20 and 5 times, respectively. These cases suggest that continuous hemofiltration or hemodiafiltration may be effective in reducing toxic concentrations of FK 506 in the plasma. The 1st case also implies that continuous hemofiltration may be a viable alternative when hemodialysis fails to provide appropriate drug clearance.