Introduction: The introduction of generic immunosuppressants may offer an opportunity for cost savings in intestinal and other solid organ transplantation if equivalent clinical outcomes to the branded counterparts can be achieved.

Methods: At our center 14 clinically stable adult intestinal/multivisceral transplant recipients were switched from Prograf (®) to Adoport (®) starting from 1st January 2018: 8 male and 6 female; 11 of them underwent isolated intestinal transplant, 3 of them multivisceral transplant (1 associated with abdominal wall transplant). After the immunosuppression switch we conducted an acute monitoring with regard to safety and efficacy: acute cellular rejection on intestinal biopses and tacrolimus C0 levels were checked every 3 months. Pre conversion tacrolimus level was compared to those revealed at 3, 6, 9 and 12 months after conversion; at the same timepoint an intestinal endoscopy and biopsy was performed.

Results: After 1 year of follow up from the conversion, tacrolimus C0 levels did not canged (pre conversion mean level 5.1 ng/mL ± 1.8 vs 4.8 ng/mL ± 1.7, 5 ng/mL ± 1.7, 5.1 ng/mL ± 1.9, 5.2 ng/mL ± 1.9 respectively at 3, 6, 9 and 12 months after tacrolimus conversion). Survival was 100% of the patients. No episodes of ACR or enteritis or other complication were collected. No patient reverted back to gtand name tacrolimus.

Conclusion: Our clinical experience as well as research data showed that the use of generic tacrolimus results in comparable trough concentration. Given the lack of adverse events reported and the cost savings recognized, conversion from brand name tacrolimus to generic one should be encouraged also in intestinal transplant recipients