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Predictors of reduced tacrolimus dose and trough level through 36 months post‐transplant among 578 adult primary kidney transplant recipients
Author(s) -
Gaynor Jeffrey J.,
Ciancio Gaetano,
Guerra Giselle,
Sageshima Junichiro,
Roth David,
Chen Linda,
Kupin Warren,
Mattiazzi Adela,
Tueros Lissett,
Flores Sandra,
Hanson Lois,
Vianna Rodrigo,
Burke George W.
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12340
Subject(s) - tacrolimus , medicine , dosing , trough level , trough concentration , immunosuppression , urology , kidney transplantation , kidney transplant , cohort , transplantation
Background A multivariable linear regression model including baseline and immunosuppression‐related predictors of the post‐kidney transplant tacrolimus dose/day required for achieving a target tacrolimus trough level of 4–8 ng/mL (currently accepted reduced tacrolimus dosing strategy) would provide a practical guide to clinicians. Methods Using our prospectively followed cohort of 578 adult primary kidney transplant recipients assigned to receive reduced tacrolimus dosing as part of maintenance therapy, we determined the significant predictors of absolute tacrolimus dose (mg), tacrolimus trough level (ng/mL), and dose‐adjusted tacrolimus trough level (%/L) during the first 36 months post‐transplant. Results Two demographic variables were associated with a significantly higher tacrolimus dose at each post‐transplant time analyzed: A frican A merican recipient (p < 0.1) and younger recipient age (p ≤ 0.00009). Use of maintenance corticosteroids was also associated with a significantly higher tacrolimus dose but only during the first 12 months post‐transplant (p ≤ 0.002). None of the other baseline variables (or use of sirolimus) were predictive of tacrolimus dose, and none of these factors were associated with the tacrolimus trough level (thus, effective therapeutic drug monitoring was achieved). Results for dose‐adjusted tacrolimus trough level were inversely related to the tacrolimus dose findings. Conclusions Significantly higher tacrolimus dosing to achieve the target tacrolimus trough level (lower bioavailability) was required, but only among A frican A mericans, younger recipients, and those receiving maintenance corticosteroids.