Comparison of Transplant Outcomes for Low-level and Standard-level Tacrolimus at Different Time Points after Kidney Transplantation
10.3346/jkms.2019.34.e103
- Author:
Hee Yeon JUNG
1
;
Sun Young CHO
;
Ji Young CHOI
;
Jang Hee CHO
;
Sun Hee PARK
;
Yong Lim KIM
;
Hyung Kee KIM
;
Seung HUH
;
Dong Il WON
;
Chan Duck KIM
Author Information
1. Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea. drcdkim@knu.ac.kr
- Publication Type:Original Article
- Keywords:
Tacrolimus;
Trough Level;
Acute Rejection;
Kidney Transplantation
- MeSH:
Allografts;
Calcineurin;
Drug-Related Side Effects and Adverse Reactions;
Glomerular Filtration Rate;
Humans;
Immunosuppression;
Incidence;
Kidney Transplantation;
Kidney;
Opportunistic Infections;
Tacrolimus;
Transplant Recipients
- From:Journal of Korean Medical Science
2019;34(12):e103-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Optimal tacrolimus (TAC) trough levels for different periods after kidney transplantation (KT) has not been definitely established. This study aimed to investigate transplant outcomes of low-level (LL) and standard-level (SL) TAC according to post-transplant period. METHODS: A total of 278 consecutive kidney transplant recipients (KTRs) receiving TAC-based immunosuppression were divided into LL and SL-TAC groups (4–7 and 7–12 ng/mL for 0–2 months, 3–6 and 6–10 ng/mL for 3–6 months, 2–5 and 5–8 ng/mL for 7–12 months, respectively) according to TAC trough level at each period. We compared estimated glomerular filtration rate (eGFR), biopsy-proven acute rejection (BPAR), de novo donor-specific antibody (dnDSA), calcineurin inhibitor (CNI) toxicity, opportunistic infection, and allograft survival. RESULTS: SL-TAC group showed significantly higher mean eGFR at 0–2 months than LL-TAC group (72.1 ± 20.3 vs. 64.2 ± 22.7 mL/min/1.73m2; P = 0.003). Incidence of BPAR at 7–12 months was significantly lower in SL-TAC group than in LL-TAC group (0.0% vs. 3.9%; P = 0.039). Patients with persistent SL-TAC lasting 12 months showed higher eGFR at 7–12 months than those with persistent LL-TAC (65.5 ± 13.0 vs. 57.9 ± 13.9 mL/min/1.73m2; P = 0.007). No significant differences in dnDSA, CNI toxicity, serious infections, or allograft survival were observed. CONCLUSIONS: Maintenance of proper TAC trough level after 6 months could reduce BPAR without adverse drug toxicities in KTRs. Moreover, persistent SL-TAC during the first year after KT might have a beneficial effect on a trend for a lower incidence of dnDSA and better renal allograft function.
