title: Higher tacrolimus trough levels on days 2-5 post-renal transplant are associated with reduced rates of acute rejection.
abstract: We analyzed the association between whole-blood trough tacrolimus (TAC) levels in the first days post-kidney transplant and acute cellular rejection (ACR) rates. Four hundred and sixty-four consecutive, deceased-donor kidney transplant recipients were included. All were treated with a combination of TAC, mycophenolate mofetil and prednisolone. Patients were analyzed in four groups based on quartiles of the mean TAC on days 2 and 5 post-transplant: Group 1: median TAC 11 ng/mL (n = 122, range 2-13.5 ng/mL), Group 2: median 17 ng/mL (n = 123, range 14-20 ng/mL), Group 3: median 24 ng/mL (n = 108, range 20.5-27 ng/mL) and Group 4: median 33.5 ng/mL (n = 116, range 27.5-77.5 ng/mL). A graded reduction in the rates of ACR was observed for each incremental days 2-5 TAC. The one-yr ACR rate was 24.03% (95% CI 17.26-32.88), 22.20% (95% CI 15.78-30.70), 13.41% (95% CI 8.15-21.63) and 8.69% (95% CI 4.77-15.55) for Groups 1-4, respectively (p = 0.003). This study suggests that higher early TACs are associated with reduced rates of ACR at one yr.
authors.affiliation: Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland.
authors.forename: C M
authors.initials: CM
authors.lastname: O'Seaghdha
authors.forename: R
authors.initials: R
authors.lastname: McQuillan
authors.forename: A M
authors.initials: AM
authors.lastname: Moran
authors.forename: P
authors.initials: P
authors.lastname: Lavin
authors.forename: A
authors.initials: A
authors.lastname: Dorman
authors.forename: P
authors.initials: P
authors.lastname: O'Kelly
authors.forename: D M
authors.initials: DM
authors.lastname: Mohan
authors.forename: P
authors.initials: P
authors.lastname: Little
authors.forename: D P
authors.initials: DP
authors.lastname: Hickey
authors.forename: P J
authors.initials: PJ
authors.lastname: Conlon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D016559:Tacrolimus / Q000097:blood* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus