title: Low-target tacrolimus in de novo standard risk renal transplant recipients: A single-centre experience.
abstract: OBJECTIVE
  Optimal tacrolimus exposure in transplant recipients is not well established. The results from the Symphony study indicated that low-target tacrolimus (trough concentrations 3-7 µg/L) in de novo standard risk renal transplant recipients should be appropriate. The aim of this study was to evaluate real-life outcomes when applying a similar strategy in a clinical setting.
  
  
  METHODS
  A single-centre analysis was conducted in standard risk renal transplant recipients receiving low-target tacrolimus, mycophenolate mofetil, glucocorticoids and basiliximab induction. One-year estimated glomerular filtration rate (eGFR, Cockcroft-Gault), one-year biopsy-proven acute rejection rate and graft- and patient survival up to 3 years post-transplant were compared with the outcomes in the Symphony study.
  
  
  RESULTS
  From 1 January 2009 to 31 March 2013, we included 406 patients. One year after transplantation, the mean ± SD eGFR was 76.8 ± 28.3 mL/min (Symphony: 65.4 ± 27.0 mL/min, P < 0.001). Biopsy-proven acute rejections were seen in 14.5% of the patients (Symphony: 12.3%, P = 0.35). Kaplan-Meier estimates [95% confidence interval] of three-year death-censored graft- and patient survival were 96.6% [94.2-99.0%] (Symphony: 93%) and 95.0% [92.6-97.3%] (Symphony: 95%), respectively.
  
  
  CONCLUSIONS
  Low-target tacrolimus-based immunosuppression is safe and effective also in a standard clinical setting in de novo standard risk renal transplant recipients.
authors: Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors: Elisabet
authors: E
authors: Størset
authors: Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.|School of Pharmacy, University of Oslo, Oslo, Norway.
authors: Anders
authors: A
authors: Åsberg
authors: Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors: Anders
authors: A
authors: Hartmann
authors: Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors: Anna V
authors: AV
authors: Reisaeter
authors: Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors: Hallvard
authors: H
authors: Holdaas
authors: Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors: Morten
authors: M
authors: Skauby
authors: School of Pharmacy, University of Oslo, Oslo, Norway.|Department of Pharmacology, Oslo University Hospital, Oslo, Norway.
authors: Stein
authors: S
authors: Bergan
authors: Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. kmidtved@ous-hf.no.
authors: Karsten
authors: K
authors: Midtvedt
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D000077552:Basiliximab; D001706:Biopsy; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects; D009664:Norway / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D020379:Risk Adjustment; D016019:Survival Analysis; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000911:Antibodies, Monoclonal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: calcineurin inhibitors; immunosuppression; kidney transplantation; symphony trial; tacrolimus