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High tacrolimus trough level variability is associated with rejections after heart transplant.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2018 Oct; Vol. 18 (10), pp. 2571-2578. Date of Electronic Publication: 2018 Aug 13. - Publication Year :
- 2018
-
Abstract
- Tacrolimus, the major immunosuppressant after heart transplant (HTx) therapy, is a narrow therapeutic index drug. Hence, achieving stable therapeutic steady state plasma concentrations is essential to ensure efficacy while avoiding toxicity. Whether high variability in steady state concentrations is associated with poor outcomes is unknown. We investigated the association between tacrolimus trough level variability during the first year post-HTx and outcomes during and beyond the first postoperative year. Overall, 72 patients were analyzed for mortality, of whom 65 and 61 were available for rejection analysis during and beyond the first year post-HTx, respectively. Patients were divided into high (median >28.8%) and low tacrolimus level variability (<28.8%) groups. Mean tacrolimus levels did not differ between the groups (12.7 ± 3.4 ng/mL vs 12.8 ± 2.4 ng/mL, P = .930). Patients in the high variability group exhibited higher long-term rejection rate (median total rejection score: 0.33 vs 0, P = .04) with no difference in rejection scores within the first year post-HTx. Multivariate analysis showed that high tacrolimus trough level variability was associated with >8-fold increased risk for any rejection beyond the first year post-HTx (P = .011). Mortality was associated only with cardiovascular complications (P = .018), with no effect of tacrolimus through level variability.<br /> (© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Subjects :
- Adult
Female
Follow-Up Studies
Graft Rejection etiology
Graft Rejection metabolism
Graft Survival
Humans
Immunosuppressive Agents administration & dosage
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Factors
Tacrolimus administration & dosage
Tissue Distribution
Drug Monitoring
Graft Rejection diagnosis
Heart Transplantation adverse effects
Immunosuppressive Agents pharmacokinetics
Postoperative Complications
Tacrolimus pharmacokinetics
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6143
- Volume :
- 18
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 29989311
- Full Text :
- https://doi.org/10.1111/ajt.15016