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Lower versus higher starting tacrolimus dosing in kidney transplant recipients

Achieving therapeutic tacrolimus levels is an essential component of balancing immunosuppression in kidney transplantation. At our institution, the starting tacrolimus dose was reduced from .075 mg/kg BD (higher dose [HD]) to .050 mg/kg BD (lower dose [LD]), to better achieve our target level of 6–1...

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Autores principales: Chua, Justin C. M., Mount, Peter F., Lee, Darren
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286038/
https://www.ncbi.nlm.nih.gov/pubmed/35137970
http://dx.doi.org/10.1111/ctr.14606
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author Chua, Justin C. M.
Mount, Peter F.
Lee, Darren
author_facet Chua, Justin C. M.
Mount, Peter F.
Lee, Darren
author_sort Chua, Justin C. M.
collection PubMed
description Achieving therapeutic tacrolimus levels is an essential component of balancing immunosuppression in kidney transplantation. At our institution, the starting tacrolimus dose was reduced from .075 mg/kg BD (higher dose [HD]) to .050 mg/kg BD (lower dose [LD]), to better achieve our target level of 6–10 μg/L in the early posttransplant period. Kidney transplant recipients (KTRs) transplanted 1‐year before (HD: n = 64) and after (LD: n = 63) the starting dose reduction were retrospectively compared. Achieved tacrolimus levels were significantly lower in the LD group during the first 14 days posttransplant, but not at day 21 or day 28. A higher proportion of LD KTRs achieved therapeutic levels (day 1–3: 36.1% vs. 18.8%; day 4–7: 50.8% vs. 40.6%, day 8–14: 83.6% vs. 71.7%), while the HD KTRs were more likely to have supratherapeutic levels. Tacrolimus dose was significantly lower on day 5 compared to day 0 in the HD group but similar in the LD group. Rates of delayed graft function, posttransplant diabetes, and treated rejection at 6 months and graft outcomes at 3 years were all similar. Lowering the starting tacrolimus dose increased the proportion of KTRs achieving therapeutic range and minimized dose changes early posttransplant without an impact on clinical outcomes.
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spelling pubmed-92860382022-07-19 Lower versus higher starting tacrolimus dosing in kidney transplant recipients Chua, Justin C. M. Mount, Peter F. Lee, Darren Clin Transplant Brief Communication Achieving therapeutic tacrolimus levels is an essential component of balancing immunosuppression in kidney transplantation. At our institution, the starting tacrolimus dose was reduced from .075 mg/kg BD (higher dose [HD]) to .050 mg/kg BD (lower dose [LD]), to better achieve our target level of 6–10 μg/L in the early posttransplant period. Kidney transplant recipients (KTRs) transplanted 1‐year before (HD: n = 64) and after (LD: n = 63) the starting dose reduction were retrospectively compared. Achieved tacrolimus levels were significantly lower in the LD group during the first 14 days posttransplant, but not at day 21 or day 28. A higher proportion of LD KTRs achieved therapeutic levels (day 1–3: 36.1% vs. 18.8%; day 4–7: 50.8% vs. 40.6%, day 8–14: 83.6% vs. 71.7%), while the HD KTRs were more likely to have supratherapeutic levels. Tacrolimus dose was significantly lower on day 5 compared to day 0 in the HD group but similar in the LD group. Rates of delayed graft function, posttransplant diabetes, and treated rejection at 6 months and graft outcomes at 3 years were all similar. Lowering the starting tacrolimus dose increased the proportion of KTRs achieving therapeutic range and minimized dose changes early posttransplant without an impact on clinical outcomes. John Wiley and Sons Inc. 2022-02-23 2022-06 /pmc/articles/PMC9286038/ /pubmed/35137970 http://dx.doi.org/10.1111/ctr.14606 Text en © 2022 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Brief Communication
Chua, Justin C. M.
Mount, Peter F.
Lee, Darren
Lower versus higher starting tacrolimus dosing in kidney transplant recipients
title Lower versus higher starting tacrolimus dosing in kidney transplant recipients
title_full Lower versus higher starting tacrolimus dosing in kidney transplant recipients
title_fullStr Lower versus higher starting tacrolimus dosing in kidney transplant recipients
title_full_unstemmed Lower versus higher starting tacrolimus dosing in kidney transplant recipients
title_short Lower versus higher starting tacrolimus dosing in kidney transplant recipients
title_sort lower versus higher starting tacrolimus dosing in kidney transplant recipients
topic Brief Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286038/
https://www.ncbi.nlm.nih.gov/pubmed/35137970
http://dx.doi.org/10.1111/ctr.14606
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