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Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk.
- Source :
-
Scientific reports [Sci Rep] 2021 Jun 09; Vol. 11 (1), pp. 12114. Date of Electronic Publication: 2021 Jun 09. - Publication Year :
- 2021
-
Abstract
- High intra-patient variability (IPV) of tacrolimus trough concentrations is increasingly recognized as a predictor of poor long-term outcomes in kidney transplant. However, there is a lack of information regarding the association between tacrolimus IPV and graft outcomes according to immunological risk. We analyzed tacrolimus IPV using the coefficient of variability from months 6-12 after transplantation in 1080 kidney transplant recipients. Patients were divided into two immunological risk groups based on pre-transplant panel reactive antibodies and donor-specific antibodies. High immunological risk was defined as panel reactive antibodies ≥ 20% or the presence of donor-specific antibodies. The effects of tacrolimus IPV on graft outcomes were significantly different between low and high immunological risk patients. A multivariable Cox regression model confirmed that high tacrolimus IPV was an independent risk factor for graft failure in the high risk group (HR, 2.90; 95% CI, 1.42-5.95, P = 0.004). In the high risk group, high tacrolimus IPV was also significantly associated with increased risk of antibody-mediated rejection (P = 0.006). In contrast, death-censored graft survival and antibody-mediated rejection in the low immunological risk group was not significantly different by tacrolimus IPV. High tacrolimus IPV significantly increases the risk of graft failure and antibody-mediated rejection in patients with high immunological risk.
- Subjects :
- Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Rejection drug therapy
Graft Rejection etiology
Humans
Immunosuppressive Agents therapeutic use
Kidney Function Tests
Male
Middle Aged
Postoperative Complications drug therapy
Postoperative Complications etiology
Prognosis
Retrospective Studies
Risk Factors
Graft Rejection pathology
Graft Survival drug effects
Kidney Failure, Chronic surgery
Kidney Transplantation adverse effects
Postoperative Complications pathology
Tacrolimus therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 2045-2322
- Volume :
- 11
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Scientific reports
- Publication Type :
- Academic Journal
- Accession number :
- 34108576
- Full Text :
- https://doi.org/10.1038/s41598-021-91630-4