title: Medium-Term Renal Function in a Large Cohort of Stable Kidney Transplant Recipients Converted From Twice-Daily to Once-Daily Tacrolimus.
abstract: BACKGROUND
  There is some evidence pointing toward better renal function in kidney transplant recipients (KTR) treated with once-daily tacrolimus (QD-TAC) vs. twice-daily tacrolimus (BID-TAC).
  
  
  METHODS
  This is an extension study of a 1-year, single arm prospective study of stable KTR who were converted from BID-TAC to QD-TAC (4.9 ± 4.0 years after transplantation) in Spanish routine clinical practice. Patient and graft survival, renal function, acute rejection episodes, and other analytic parameters were assessed at 24 and 36 months after conversion.
  
  
  RESULTS
  A total of 1798 KTR were included in the extension study. Tacrolimus doses at 36 months were significantly lower compared to those at time of conversion (-0.2 mg/day; P = 0.023). Blood levels were lower than baseline during all the study (P < 0.001). Graft and patient survival at 3 years after conversion were 93.9% and 95.1%, respectively. Compared with baseline, the mean estimated glomerular filtration rate (eGFR) remained very stable at all timepoints (56.7 ± 19.8 vs 58.1 ± 24.6 mL/min per 1.73 m(2) at month 36; P = 0.623). Even when patients reinitiating dialysis were counted as eGFR = 0, the mean eGFR was very stable. In fact, a small but significant increase was observed at 36 months versus baseline (+0.1 mL/min per 1.73 m(2); P = 0.025). An increase in proteinuria was observed at 36 months versus baseline (+0.11 g/24 h; P < 0.001). Acute rejection rates were low during the study.
  
  
  CONCLUSIONS
  Conversion from BID-TAC to QD-TAC in a large cohort of stable KTR was safe and associated with a very stable renal function after 3 years. Comparative studies are warranted to assess the feasibility of such conversion.
authors: Renal Transplant Unit, Fundació Puigvert, Barcelona, Spain.
authors: Lluís
authors: L
authors: Guirado
authors: Nephrology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
authors: Dolores
authors: D
authors: Burgos
authors: Nephrology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain.
authors: Carme
authors: C
authors: Cantarell
authors: Nephrology Department, Hospital Ramón y Cajal, Madrid, Spain.
authors: Ana
authors: A
authors: Fernández
authors: Nephrology Department, Hospital General de Alicante, Alicante, Spain.
authors: Antonio
authors: A
authors: Franco
authors: Clinical Nephrology and Urology Unit, Hospital Virgen del Rocío, Sevilla, Spain.
authors: Miguel Ángel
authors: MÁ
authors: Gentil
authors: Nephrology Department, Hospital Puerta del Mar, Cádiz, Spain.
authors: Auxiliadora
authors: A
authors: Mazuecos
authors: Renal Transplant Unit, Hospital Clínic Barcelona, Spain.
authors: Josep Vicenç
authors: JV
authors: Torregrosa
authors: Nephrology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Ernesto Gómez
authors: EG
authors: Huertas
authors: Nephrology Department, Hospital Marqués de Valdecilla, Santander, Spain.
authors: Juan Carlos
authors: JC
authors: Ruiz
authors: Nephrology Department, Hospital La Fe, Valencia, Spain.
authors: Jaime Sánchez
authors: JS
authors: Plumed
authors: Nephrology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors: Javier
authors: J
authors: Paul
authors: Nephrology Department, Hospital Germans Trias i Pujol, Barcelona, Spain.
authors: Ricardo
authors: R
authors: Lauzurica
authors: Nephrology Department, Hospital de Cruces, Bilbao, Spain.
authors: Sofía
authors: S
authors: Zárraga
authors: Nephrology Department, Hospital Virgen de las Nieves, Granada, Spain.
authors: Antonio
authors: A
authors: Osuna
authors: Nephrology Department, Hospital La Paz, Madrid, Spain.
authors: Carlos
authors: C
authors: Jiménez
authors: Nephrology Department, Complejo Hospitalario A Coruña, A Coruña, Spain.
authors: Ángel
authors: Á
authors: Alonso
authors: Nephrology Department, Hospital Reina Sofia, Córdoba, Spain.
authors: Alberto
authors: A
authors: Rodríguez
authors: Statistics Department, Fundació Puigvert, Barcelona, Spain.
authors: Beatriz
authors: B
authors: Bardají
authors: Nephrology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
authors: Domingo
authors: D
authors: Hernández