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Late intra‐patient tacrolimus trough level variability as a major problem in kidney transplantation: A Collaborative Transplant Study Report
Author(s) -
Süsal Caner,
Döhler Bernd
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15346
Subject(s) - medicine , tacrolimus , kidney transplantation , trough (economics) , transplantation , trough level , kidney transplant , trough concentration , intensive care medicine , urology , pharmacokinetics , economics , macroeconomics
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.