Abstract:
BACKGROUND:Patients with high tacrolimus clearance eliminate more drug within a dose interval compared with those with low clearance. Delays in dosing time will result in transient periods of lower concentrations in high versus low clearance patients. Transient subtherapeutic tacrolimus concentrations may induce acute rejection episodes. METHODS:A retrospective study in all renal transplant patients treated with tacrolimus at our center from 2009 to 2013 was conducted. The association between individually estimated tacrolimus clearance (daily tacrolimus dose [mg]/trough concentration [μg/L]) and biopsy-proven acute rejection (BPAR) the first 90 days posttransplantation was investigated. RESULTS:In total, 638 patients treated with oral tacrolimus were included in the analysis. Eighty-five (13.3%) patients experienced BPAR. Patients were stratified into 4 groups per their estimated clearance. The patients in the high clearance group had significantly higher incidence of BPAR (20.6%) with a hazard ratio of 2.39 (95% confidence interval, 1.30-4.40) compared with the low clearance group. Clearance estimate (as a continuous variable) showed a hazard ratio of 2.25 (95% confidence interval, 1.70-2.99) after adjusting for other risk factors. There were no significant differences in neither trough concentrations the first week after transplantation nor time to target trough concentration between patients later experiencing BPAR or not. CONCLUSIONS:High estimated clearance is significantly associated with increased risk of BPAR the first 90 days posttransplantation and may predict an increased risk of rejection in the early phase after renal transplantation.
journal_name
Transplantationjournal_title
Transplantationauthors
Egeland EJ,Robertsen I,Hermann M,Midtvedt K,Størset E,Gustavsen MT,Reisæter AV,Klaasen R,Bergan S,Holdaas H,Hartmann A,Åsberg Adoi
10.1097/TP.0000000000001796subject
Has Abstractpub_date
2017-08-01 00:00:00pages
e273-e279issue
8eissn
0041-1337issn
1534-6080journal_volume
101pub_type
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