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Initial liver graft function is a reliable predictor of tacrolimus trough levels during the first post‐transplant week
Author(s) -
Lock Johan F.,
Malinowski Maciej,
Schwabauer Eugen,
Martus Peter,
Pratschke Johann,
Seehofer Daniel,
Puhl Gero,
Neuhaus Peter,
Stockmann Martin
Publication year - 2011
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/j.1399-0012.2010.01264.x
Subject(s) - medicine , tacrolimus , liver transplantation , trough level , gastroenterology , trough concentration , liver function , urology , transplantation , liver function tests , receiver operating characteristic , surgery , pharmacokinetics
Lock JF, Malinowski M, Schwabauer E, Martus P, Pratschke J, Seehofer D, Puhl G, Neuhaus P, Stockmann M. Initial liver graft function is a reliable predictor of tacrolimus trough levels during the first post‐transplant week.
Clin Transplant 2011: 25: 436–443. © 2010 John Wiley & Sons A/S. Abstract: The narrow therapeutic range of tacrolimus requires careful management after liver transplantation (LT). The aim of this study was to investigate the influence of graft function on tacrolimus trough levels during the first post‐transplant week. Ninety‐three patients receiving deceased‐donor LT were observed in a prospective observational study. Graft function was determined by the new LiMAx test (maximal liver function capacity). Significant correlations between LiMAx readouts and consecutive tacrolimus levels, up to r = −0.529 (p < 0.0001), were determined throughout the observed period of time. Patients with initially poor graft function revealed higher trough levels (n = 24; 20.1 ± 11.6 ng/mL) in comparison with fair (n = 40; 13.7 ± 7.8 ng/mL) and good function (n = 29; 9.5 ± 4.4 ng/mL; p < 0.0001) already at the second post‐transplant day. Toxic levels could be predicted with an area under receiver operating characteristic analysis AUROC=0.751 (p = 0.001) with high sensitivity and specificity. Insufficient levels could be predicted with AUROC=0.800 (p = 0.003). In conclusion, initial graft function is a major factor influencing the pharmacokinetics of tacrolimus and can be validly determined by the LiMAx test. Thus, recipients with poor functioning grafts are prone of developing toxic levels within the first week after LT, whereas patients with good functioning grafts frequently develop insufficient levels with the current immunosuppressive protocols.