Shehzad Rehman1, Xuerong Wen1, Michael J Casey1, Alfonso H Santos1, Kenneth Andreoni2. 1. Division of Nephrology, Hypertension & Renal Transplantation, Department of Medicine, University of Florida, Gainesville, USA. 2. Division of Transplantation Surgery, Department of Surgery, University of Florida, Gainesville, USA.
Abstract
BACKGROUND: There is a paucity of modern data on the impact of high tacrolimus levels early after kidney transplantation. MATERIAL/ METHODS: This study analyzed the impact of various trough levels of tacrolimus in the first 2 weeks post-transplant on rates of delayed graft function (DGF), length of stay (LoS), hyperkalemia, hyperglycemia, and biopsy-proven acute rejection (BPAR) rates in the first 3 months post-transplant in a retrospective single-center cohort of patients. Patients were divided into 4 groups based on the average of two highest 12-hour trough tacrolimus levels: <10 ng/mL, 10-12 ng/mL, 12-15 ng/mL, >15 ng/mL. RESULTS: The incidence of DGF was noted to be significantly higher in the <10 ng/mL, >15 ng/mL and the 12-15 ng/mL tacrolimus groups as compared to the 10-12 ng/mL group (49%, 25% and 4%, respectively, p≤0.0001). Mean LoS was also noted to be significantly higher in the >15 ng/mL tacrolimus group as compared to the 10-12 ng/mL group (7.4 days and 6.1 days respectively, p=0.0007). There was no difference in the rates of hyperkalemia, hyperglycemia or BPAR. CONCLUSIONS: This is a modern confirmation of the association between higher tacrolimus levels early after kidney transplantation and increased rate of DGF and increased LoS.
BACKGROUND: There is a paucity of modern data on the impact of high tacrolimus levels early after kidney transplantation. MATERIAL/ METHODS: This study analyzed the impact of various trough levels of tacrolimus in the first 2 weeks post-transplant on rates of delayed graft function (DGF), length of stay (LoS), hyperkalemia, hyperglycemia, and biopsy-proven acute rejection (BPAR) rates in the first 3 months post-transplant in a retrospective single-center cohort of patients. Patients were divided into 4 groups based on the average of two highest 12-hour trough tacrolimus levels: <10 ng/mL, 10-12 ng/mL, 12-15 ng/mL, >15 ng/mL. RESULTS: The incidence of DGF was noted to be significantly higher in the <10 ng/mL, >15 ng/mL and the 12-15 ng/mL tacrolimus groups as compared to the 10-12 ng/mL group (49%, 25% and 4%, respectively, p≤0.0001). Mean LoS was also noted to be significantly higher in the >15 ng/mL tacrolimus group as compared to the 10-12 ng/mL group (7.4 days and 6.1 days respectively, p=0.0007). There was no difference in the rates of hyperkalemia, hyperglycemia or BPAR. CONCLUSIONS: This is a modern confirmation of the association between higher tacrolimus levels early after kidney transplantation and increased rate of DGF and increased LoS.
Authors: Bram C S de Vries; Stefan P Berger; Stephan J L Bakker; Martin H de Borst; Margriet F C de Jong Journal: Nephron Date: 2020-11-19 Impact factor: 2.847
Authors: Maria Smyrli; Pantelis A Sarafidis; Charalampos Loutradis; Maria Korogiannou; Ioannis N Boletis; Smaragdi Marinaki Journal: Clin Kidney J Date: 2021-07-10