title: Risk Factors for the Adverse Events after Conversion from Twice-Daily to Once-Daily Tacrolimus in Stable Liver Transplantation Patients.
abstract: Despite the therapeutic equivalence between twice-daily and once-daily tacrolimus, patient safety after conversion is still a concern. We reviewed 218 liver transplantation (LT) patients who converted twice-daily to once-daily tacrolimus between May 2011 and January 2014. Thirty (13.8%) patients had adverse events after conversion, with a liver function test (LFT) abnormality being the most common adverse event (n = 17). Despite the decrease in serum tacrolimus of > 30% after conversion, none of the patients who were converted to a dosage ratio (once-daily tacrolimus dosage: twice-daily tacrolimus dosage) > 1 had an LFT abnormality. Most patients with an LFT abnormality improved after increasing the once-daily tacrolimus dosage (n = 2), returned to a previous medication, and/or added another immunosuppressant (n = 15). One patient had acute cellular rejection, which improved after steroid pulse treatment, and another patient had graft failure. In patients with a dosage ratio ≤ 1, the conversion time within 5 years after LT was the only significant risk factor for an LFT abnormality after conversion (odds ratio: 11.850, 95% confidence interval: 1.321-106.325, P = 0.027). In conclusion, the dosage ratio and time after LT should be carefully considered during conversion from twice-daily to once-daily tacrolimus.
authors.affiliation: Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea.|Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Suk Won
authors.identifier: http://orcid.org/0000-0001-6111-9601
authors.initials: SW
authors.lastname: Suh
authors.affiliation: Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea. Kwleegs@gmail.com.
authors.forename: Kwang Woong
authors.identifier: http://orcid.org/0000-0001-6412-1926
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Jaehong
authors.identifier: http://orcid.org/0000-0002-7749-039X
authors.initials: J
authors.lastname: Jeong
authors.affiliation: Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Hyeyoung
authors.identifier: http://orcid.org/0000-0002-3157-8214
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Nam Joon
authors.identifier: http://orcid.org/0000-0002-5467-425X
authors.initials: NJ
authors.lastname: Yi
authors.affiliation: Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Kyung Suk
authors.identifier: http://orcid.org/0000-0002-9535-7349
authors.initials: KS
authors.lastname: Suh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use*; D017093:Liver Failure / Q000628:therapy; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Adverse Events; Conversion; Liver Transplantation; Once-daily Tacrolimus; Twice-daily Tacrolimus