Tacrolimus Intrapatient Variability on Graft Outcomes in Adherent Renal Transplantation Patients: A Cross-Sectional Study

被引:0
作者
Nafar, Mohsen [1 ]
Keshtkari, Sara [1 ]
Ziaie, Shadi [2 ]
Firouzan, Ahmad [1 ]
Borumandnia, Nasrin [3 ]
Dalili, Nooshin [1 ]
Poorrezagholi, Fatemeh [1 ]
Samadian, Fariba [1 ]
Samavat, Shiva [1 ]
机构
[1] Shahid Beheshti Univ Med Sci SBMU, Chron Kidney Dis Res Ctr CKDRC, Shahid Labbafinejad Med Ctr, Tehran, Iran
[2] Shahid Beheshti Univ Med Sci, Sch Pharm, Clin Pharm Dept, Tehran, Iran
[3] Shahid Beheshti Univ Med Sci SBMU, Urol & Nephrol Res Ctr UNRC, Tehran, Iran
关键词
transplantation; intrapatient variability; IPV; coefficient variation; tacrolimus; acute rejection; KIDNEY-TRANSPLANT; BLOOD-LEVELS; RECIPIENTS; RISK;
D O I
10.52547/ijkd.7815
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction. Tacrolimus is the mainstem of immunosuppressive therapy in kidney transplant patients. It has high intrapatient variability (Tac-IPV), which has been reported to affect graft function by predisposing patients to rejection or nephrotoxicity. We conducted this study with the aim of assessing the influence of Tac-IPV on 2-year graft function, biopsy-proven rejection, and infections in compliant renal recipients. Methods. In this single-center retrospective analytic cross-sectional study, 250 patients who underwent transplantation from March 21, 2018, to March 20, 2020 and had at least three outpatient tacrolimus trough levels on the same daily dose 6 to 12 months after transplantation were recruited. Tac-IPV was defined as a coefficient variation of > 15%. Graft function, biopsy-proven rejection, cytomegalovirus (CMV) and BK virus viremia, and calcineurin inhibitor (CNI) toxicity were evaluated. Results. Of 202 transplant recipients, 128 were included with a mean age of 45.48 +/- 13.14 years. The median Tac-IPV was 13.28% with 43.75% of patients with Tac-IPV > 15%. There were no significant differences in graft function, rejection, CNI toxicity, and CMV viremia among the groups during the 24-month study ( P > .05). However, BK viremia was significantly higher among patients with Tac-IPV > 15% (13 vs. 2.9%, P = .042). The risk of antibodymediated rejection alone (22.7 vs. 2.9%) or any kind of rejection (22.7 vs. 11.8%) was significantly higher in patients with higher Tac-IPV, and in those who had mean trough levels below 7 ng/ mL ( P = .015, .032; respectively). Conclusion. Tac-IPV is low in adherent patients (with the median of 13.28%) and maintaining tacrolimus trough level above 7 ng/mL can overcome the adverse graft outcome of Tac-IPV in compliant kidney transplant recipients.
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页码:187 / 194
页数:8
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