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Late intra-patient tacrolimus trough level variability as a major problem in kidney transplantation: A Collaborative Transplant Study Report.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2019 Oct; Vol. 19 (10), pp. 2805-2813. Date of Electronic Publication: 2019 Apr 10. - Publication Year :
- 2019
-
Abstract
- Intra-patient variability (IPV) of tacrolimus trough level has been associated with poor outcome after kidney transplantation. These findings were derived from single-center analyses and restricted mainly to measurements early after transplantation. We analyzed in a multicenter effort whether high IPV of tacrolimus levels at posttransplant years 1, 2, and 3 was associated with impaired clinical outcome. More than 6600 patients who received a deceased donor kidney transplant during 2000-2014 and had a functioning graft for >3 years were studied. Graft survival was significantly impaired with increasing IPV (P < 0.001). As compared to patients with a low IPV of <30%, the risk of graft loss during years 4-6 increased 32% in patients with an IPV of 30% to 44% and 66% in patients with an IPV of ≥45% (P = 0.002 and P < 0.001). About one-third of patients showed an IPV of ≥30% with substantially impaired outcome. Even in patients with good outcome during the first 3 posttransplant years, a high IPV was associated with inferior graft survival. Our data indicate that a fluctuating tacrolimus trough level at years 1, 2, and 3 posttransplant is a major problem in kidney transplantation.<br /> (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Subjects :
- Adolescent
Adult
Child
Child, Preschool
Drug Monitoring
Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Rejection drug therapy
Graft Rejection etiology
Humans
Immunosuppressive Agents administration & dosage
Immunosuppressive Agents metabolism
Infant
Infant, Newborn
Kidney Failure, Chronic metabolism
Kidney Failure, Chronic pathology
Kidney Function Tests
Male
Middle Aged
Postoperative Complications metabolism
Postoperative Complications pathology
Prognosis
Risk Factors
Tacrolimus administration & dosage
Young Adult
Graft Rejection metabolism
Graft Survival drug effects
Kidney Failure, Chronic surgery
Kidney Transplantation adverse effects
Postoperative Complications etiology
Tacrolimus metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6143
- Volume :
- 19
- 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 :
- 30859672
- Full Text :
- https://doi.org/10.1111/ajt.15346