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Intra‐patient variability in tacrolimus exposure in pediatric liver transplant recipients: Evolution, risk factors, and impact on patient outcomes
Author(s) -
Defrancq Charlotte,
De Wilde Nika,
Raes Ann,
Van Biervliet Stephanie,
Vande Velde Saskia,
Van Winckel Myriam,
De Bruyne Ruth,
Prytuła Agnieszka
Publication year - 2019
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13388
Subject(s) - medicine , tacrolimus , liver biopsy , odds ratio , hematocrit , biopsy , adverse effect , gastroenterology , retrospective cohort study , liver transplantation , transplantation
Background This study aims to investigate the evolution and factors associated with TAC IPV and its impact on patient outcomes in pediatric LT recipients. Methods This is a retrospective study including 41 children. The TAC IPV was expressed as the coefficient of variation and was calculated for years 1‐5 following LT. The number of missed clinic appointments was used as a surrogate marker for therapy adherence. Results We identified a decrease in the TAC IPV during the first 3 years after LT ( P < 0.01). Serum albumin in the first year ( P = 0.03), hematocrit ( P = 0.02) and total bilirubin ( P = 0.04) in the third year, and therapy adherence ( P < 0.01) in the fifth year were associated with TAC IPV. High TAC IPV was associated with biopsy‐proven acute allograft rejection ( P = 0.04) and the need for biopsy during the first year ( P = 0.02). There was a borderline association between TAC IPV and donor‐specific antibodies ( P = 0.08) and CMV viremia ( P = 0.07). High TAC IPV was a predictor of need for liver biopsy and AR with an odds ratio of 1.04 (95% CI 1.0‐1.1; P = 0.03) and 1.04 (95% CI 1.0‐1.1; P = 0.05), respectively. Conclusions Our results highlight the impact of biological factors on TAC IPV during the early LT follow‐up and later also therapy adherence. High TAC IPV may be associated with adverse patient outcomes.