The Tacrolimus Concentration/Dose Ratio Does Not Predict Early Complications After Kidney Transplantation

被引:2
作者
von Samson-Himmelstjerna, Friedrich Alexander [1 ]
Messtorff, Maja Lucia [1 ]
Kakavand, Nassim [1 ]
Eisenberger, Ute [2 ]
Korth, Johannes [2 ]
Lange, Ulrich [3 ]
Kolbrink, Benedikt [1 ]
Aldag, Leon [1 ]
Schulze Dieckhoff, Tobias [1 ]
Feldkamp, Thorsten [1 ]
Kunzendorf, Ulrich [1 ]
Harth, Ana [3 ]
Schulte, Kevin [1 ]
机构
[1] Univ Kiel, Univ Hosp Schleswig Holstein, Dept Nephrol & Hypertens, Kiel, Germany
[2] Essen Univ Hosp, Dept Nephrol, Essen, Germany
[3] Klinikum Univ Witten Herdecke, Krankenhaus Koln Merheim, Dept Nephrol, Cologne, Germany
关键词
kidney transplantation; tacrolimus; acute graft rejection; C; D ratio; BKV nephritis; CALCINEURIN INHIBITORS; BELATACEPT; REJECTION; PHASE;
D O I
10.3389/ti.2023.11027
中图分类号
R61 [外科手术学];
学科分类号
摘要
Early-on post kidney transplantation, there is a high risk of graft rejection and opportunistic viral infections. A low tacrolimus concentration/dose (C/D) ratio as a surrogate marker of fast tacrolimus metabolism has been established for risk stratification 3 months post-transplantation (M3). However, many adverse events occurring earlier might be missed, and stratification at 1 month post-transplantation (M1) has not been investigated. We retrospectively analyzed case data from 589 patients who had undergone kidney transplantation between 2011 and 2021 at three German transplant centers. Tacrolimus metabolism was estimated by use of the C/D ratio at M1, M3, M6, and M12. C/D ratios increased substantially during the year, particularly between M1 and M3. Many viral infections and most graft rejections occurred before M3. Neither at M1 nor at M3 was a low C/D ratio associated with susceptibility to BKV viremia or BKV nephritis. A low C/D ratio at M1 could not predict acute graft rejections or impaired kidney function, whereas at M3 it was significantly associated with subsequent rejections and impairment of kidney function. In summary, most rejections occur before M3, but a low C/D ratio at M1 does not identify patients at risk, limiting the predictive utility of this stratification approach.
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页数:10
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