title: Successful conversion from twice-daily to once-daily tacrolimus in liver transplantation: observational multicenter study.
abstract: BACKGROUND
  Compliance with immunosuppressive therapy in liver transplant patients is critical to prevent acute organ rejection and/or late graft loss. Strategies to simplify the therapeutic regimen may improve adherence.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of conversion from a twice-daily to once-daily tacrolimus formulation in adult liver transplant patients.
  
  
  METHODS
  This prospective observational multicenter study included 187 liver transplant patients with at least 10 months post-transplant follow-up, no rejection episodes in the last three months, and creatinine levels <2 mg/dL. Conversion from a twice-daily to a once-daily formulation was based on a 1:1 proportion.
  
  
  RESULTS
  Median age was 61 yr (range: 28-80 yr); 64% were men and 36% women. The main indications for liver transplant were alcoholic cirrhosis in 30%. Median conversion time was 55 months (range: 10-215 months). Serum tacrolimus levels decreased at one month after conversion (pre-conversion levels = 5.4 ± 3.0 ng/mL vs. post-conversion levels = 4.4 ± 2.4 ng/mL, p = 0.013); however, these values normalized at six months post-conversion with no changes in liver function and rejection episodes were observed only in two patients.
  
  
  CONCLUSIONS
  Conversion from a twice-daily to a once-daily tacrolimus formulation is a safe, effective strategy in the management of stable liver transplant patients.
authors.affiliation: Department of HPB Surgery and Transplants, Hospital Universitario Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain. cdopazo@vhebron.net
authors.forename: Cristina
authors.initials: C
authors.lastname: Dopazo
authors.forename: Roberto
authors.initials: R
authors.lastname: Rodriguez
authors.forename: Laura
authors.initials: L
authors.lastname: Llado
authors.forename: David
authors.initials: D
authors.lastname: Calatayud
authors.forename: Lluis
authors.initials: L
authors.lastname: Castells
authors.forename: Emilio
authors.initials: E
authors.lastname: Ramos
authors.forename: Victor
authors.initials: V
authors.lastname: Molina
authors.forename: Raquel
authors.initials: R
authors.lastname: García
authors.forename: Joan
authors.initials: J
authors.lastname: Fabregat
authors.forename: Ramon
authors.initials: R
authors.lastname: Charco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000008:administration & dosage*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus