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Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients
BACKGROUND: Little is known regarding optimal tacrolimus (TAC) trough levels after 1 year post-transplant in stable kidney transplant recipients (KTRs) who have not experienced renal or cardiovascular outcomes. This study aimed to investigate the effect of 1-year post-transplant TAC trough levels on...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332007/ https://www.ncbi.nlm.nih.gov/pubmed/32614859 http://dx.doi.org/10.1371/journal.pone.0235418 |
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author | Jung, Hee-Yeon Seo, Min Young Jeon, Yena Huh, Kyu Ha Park, Jae Berm Jung, Cheol Woong Lee, Sik Han, Seung-Yeup Ro, Han Yang, Jaeseok Ahn, Curie Choi, Ji-Young Cho, Jang-Hee Park, Sun-Hee Kim, Yong-Lim Kim, Chan-Duck |
author_facet | Jung, Hee-Yeon Seo, Min Young Jeon, Yena Huh, Kyu Ha Park, Jae Berm Jung, Cheol Woong Lee, Sik Han, Seung-Yeup Ro, Han Yang, Jaeseok Ahn, Curie Choi, Ji-Young Cho, Jang-Hee Park, Sun-Hee Kim, Yong-Lim Kim, Chan-Duck |
author_sort | Jung, Hee-Yeon |
collection | PubMed |
description | BACKGROUND: Little is known regarding optimal tacrolimus (TAC) trough levels after 1 year post-transplant in stable kidney transplant recipients (KTRs) who have not experienced renal or cardiovascular outcomes. This study aimed to investigate the effect of 1-year post-transplant TAC trough levels on long-term renal and cardiovascular outcomes and opportunistic infections in stable KTRs. METHODS: KTRs receiving TAC with mycophenolate-based immunosuppression who did not experience renal or cardiovascular outcomes within 1 year post-transplant were enrolled from a multicenter observational cohort study. Renal outcome was defined as a composite of biopsy-proven acute rejection, interstitial fibrosis and tubular atrophy, and death-censored graft loss. Cardiovascular outcome was defined as a composite of de novo cardiomegaly, left ventricular hypertrophy, and cardiovascular events. Opportunistic infections were defined as the occurrence of BK virus or cytomegalovirus infections. RESULTS: A total of 603 eligible KTRs were divided into the low-level TAC (LL-TAC) and high-level TAC (HL-TAC) groups based on a median TAC level of 5.9 ng/mL (range 1.3–14.3) at 1 year post-transplant. The HL-TAC group had significantly higher TAC trough levels at 2, 3, 4, and 5 years compared with the levels of the LL-TAC group. During the mean follow-up of 63.7 ± 13.0 months, there were 121 renal outcomes and 224 cardiovascular outcomes. In multivariate Cox regression analysis, LL-TAC and HL-TAC were not independent risk factors for renal and cardiovascular outcomes, respectively. No significant differences in the development of opportunistic infections and de novo donor-specific anti-human leukocyte antigen antibodies and renal allograft function were observed between the two groups. CONCLUSIONS: TAC trough levels after 1 year post-transplant remained at a similar level until the fifth year after kidney transplantation and were not directly associated with long-term outcomes in stable Korean KTRs who did not experience renal or cardiovascular outcomes. Therefore, in Asian KTRs with a stable clinical course, TAC trough levels higher than approximately 6 ng/mL might not be required after a year of kidney transplantation. |
format | Online Article Text |
id | pubmed-7332007 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-73320072020-07-14 Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients Jung, Hee-Yeon Seo, Min Young Jeon, Yena Huh, Kyu Ha Park, Jae Berm Jung, Cheol Woong Lee, Sik Han, Seung-Yeup Ro, Han Yang, Jaeseok Ahn, Curie Choi, Ji-Young Cho, Jang-Hee Park, Sun-Hee Kim, Yong-Lim Kim, Chan-Duck PLoS One Research Article BACKGROUND: Little is known regarding optimal tacrolimus (TAC) trough levels after 1 year post-transplant in stable kidney transplant recipients (KTRs) who have not experienced renal or cardiovascular outcomes. This study aimed to investigate the effect of 1-year post-transplant TAC trough levels on long-term renal and cardiovascular outcomes and opportunistic infections in stable KTRs. METHODS: KTRs receiving TAC with mycophenolate-based immunosuppression who did not experience renal or cardiovascular outcomes within 1 year post-transplant were enrolled from a multicenter observational cohort study. Renal outcome was defined as a composite of biopsy-proven acute rejection, interstitial fibrosis and tubular atrophy, and death-censored graft loss. Cardiovascular outcome was defined as a composite of de novo cardiomegaly, left ventricular hypertrophy, and cardiovascular events. Opportunistic infections were defined as the occurrence of BK virus or cytomegalovirus infections. RESULTS: A total of 603 eligible KTRs were divided into the low-level TAC (LL-TAC) and high-level TAC (HL-TAC) groups based on a median TAC level of 5.9 ng/mL (range 1.3–14.3) at 1 year post-transplant. The HL-TAC group had significantly higher TAC trough levels at 2, 3, 4, and 5 years compared with the levels of the LL-TAC group. During the mean follow-up of 63.7 ± 13.0 months, there were 121 renal outcomes and 224 cardiovascular outcomes. In multivariate Cox regression analysis, LL-TAC and HL-TAC were not independent risk factors for renal and cardiovascular outcomes, respectively. No significant differences in the development of opportunistic infections and de novo donor-specific anti-human leukocyte antigen antibodies and renal allograft function were observed between the two groups. CONCLUSIONS: TAC trough levels after 1 year post-transplant remained at a similar level until the fifth year after kidney transplantation and were not directly associated with long-term outcomes in stable Korean KTRs who did not experience renal or cardiovascular outcomes. Therefore, in Asian KTRs with a stable clinical course, TAC trough levels higher than approximately 6 ng/mL might not be required after a year of kidney transplantation. Public Library of Science 2020-07-02 /pmc/articles/PMC7332007/ /pubmed/32614859 http://dx.doi.org/10.1371/journal.pone.0235418 Text en © 2020 Jung et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Jung, Hee-Yeon Seo, Min Young Jeon, Yena Huh, Kyu Ha Park, Jae Berm Jung, Cheol Woong Lee, Sik Han, Seung-Yeup Ro, Han Yang, Jaeseok Ahn, Curie Choi, Ji-Young Cho, Jang-Hee Park, Sun-Hee Kim, Yong-Lim Kim, Chan-Duck Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients |
title | Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients |
title_full | Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients |
title_fullStr | Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients |
title_full_unstemmed | Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients |
title_short | Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients |
title_sort | tacrolimus trough levels higher than 6 ng/ml might not be required after a year in stable kidney transplant recipients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332007/ https://www.ncbi.nlm.nih.gov/pubmed/32614859 http://dx.doi.org/10.1371/journal.pone.0235418 |
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