Optimized Tacrolimus Therapy in the Early Stage after Renal Transplantation.
10.4174/jkss.2010.79.6.428
- Author:
Sang Il MIN
1
;
Seong Yup KIM
;
Sang Hyun AHN
;
Chin Koo CHUNG
;
Seung Kee MIN
;
Jongwon HA
;
Sang Joon KIM
Author Information
1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. sjkimgs@plaza.snu.ac.kr
- Publication Type:Original Article
- Keywords:
Kidney transplantation;
Tacrolimus;
Trough concentration;
Acute rejection;
Graft function
- MeSH:
Adult;
Glomerular Filtration Rate;
Graft Rejection;
Humans;
Immunosuppression;
Incidence;
Kidney Transplantation;
Rejection (Psychology);
Tacrolimus;
Transplants
- From:Journal of the Korean Surgical Society
2010;79(6):428-435
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Immunosuppressive regimen based on reduced-dose Tacrolimus (TAC) is widely accepted in the field of renal transplantation. However, optimal targetsfor TAC whole blood trough concentrations during the early period after kidney transplantation remain uncertain. METHODS: A total of 184 consecutive adult renal transplant recipients with triple immunosuppression (TAC/Mycophenolate/corticosteroid) were included in this study. According to the trough level of TAC at day 7 after transplantation, patients were classified as low TAC concentration (LT, <10 ng/ml, n=85), intermediate TAC concentration (IT, 10~15 ng/ml, n=75), and high TAC concentration (HT, >15 ng/ml, n=24) groups. Rate of acute rejection, graft function and side effects of TAC within 1 yr after transplantation were evaluated. RESULTS: There was no difference in trough concentrations of TAC at 2 weeks, 1 month, 3 months, 6 months and 12 months after transplantation among the three groups. Significantly higher incidence of acute rejection within 2 weeks after transplantation was observed in LT group compared with IT and HT groups (17.4%, 5.6% and 4.8%, respectively, P=0.037). HT patients showed significantly better estimated glomerular filtration rates until 6 months after transplantation than IT and LT patients (75.5+/-24.8 vs. 63.8+/-12.8 and 64.3+/-15.2 ml/min at 6 months, P=0.03). There was no significant difference in TAC toxicity in terms of post-transplant diabetes and renal toxicity. CONCLUSION: Short-term high TAC exposure immediately after kidney transplantation may provide lower incidence of acute rejection and better restoration of graft function compared with low or intermediate TAC exposure.
