Martin Jannot1, Ingrid Masson2, Eric Alamartine2, Christophe Mariat2. 1. Department of Nephrology-Dialysis-Transplantation and Renal Laboratory, University Jean Monnet, CHU Hospital Nord, Saint-Etienne, France. 2. Department of Nephrology-Dialysis-Transplantation and Renal Laboratory, University Jean Monnet, CHU Hospital Nord, Saint-Etienne, France, Metropolitan.
Abstract
BACKGROUND: Although the once-daily formulation of tacrolimus (ADVAGRAF) is approved in renal transplantation to be used immediately after surgery, conventional twice-daily formulation offers better flexibility to adjust the dosage of tacrolimus during the initial period of transplantation. MATERIAL AND METHODS: We retrospectively report here our initial experience with a strategy of an early conversion from PROGRAF to ADVAGRAF before hospital discharge. RESULTS: Forty-eight de novo renal transplant recipients were started on PROGRAF and then switched to ADVAGRAF after a median time of 11 days and 4.5 days, respectively, before discharge. In terms of tacrolimus exposure, great inter-individual heterogeneity was noted, with 56% of patients experiencing a clinically significant modification in post-switch tacrolimus blood trough levels. Modification in post-switch drug exposure was poorly predicted by change in tacrolimus daily dosage. Six-month post-transplant outcome was similar in patients converted to ADVAGRAF to that of patients who had remained on PROGRAF during the same period of time. Our data suggest that an early conversion from PROGRAF to ADVAGRAF during the hospital stay may be safely undertaken, provided tacrolimus exposure is tightly monitored in patients. CONCLUSIONS: This strategy might represent an alternative to the immediate post-transplant introduction of ADVAGRAF and needs to be clinically validated in large-scale controlled trials.
BACKGROUND: Although the once-daily formulation of tacrolimus (ADVAGRAF) is approved in renal transplantation to be used immediately after surgery, conventional twice-daily formulation offers better flexibility to adjust the dosage of tacrolimus during the initial period of transplantation. MATERIAL AND METHODS: We retrospectively report here our initial experience with a strategy of an early conversion from PROGRAF to ADVAGRAF before hospital discharge. RESULTS: Forty-eight de novo renal transplant recipients were started on PROGRAF and then switched to ADVAGRAF after a median time of 11 days and 4.5 days, respectively, before discharge. In terms of tacrolimus exposure, great inter-individual heterogeneity was noted, with 56% of patients experiencing a clinically significant modification in post-switch tacrolimus blood trough levels. Modification in post-switch drug exposure was poorly predicted by change in tacrolimus daily dosage. Six-month post-transplant outcome was similar in patients converted to ADVAGRAF to that of patients who had remained on PROGRAF during the same period of time. Our data suggest that an early conversion from PROGRAF to ADVAGRAF during the hospital stay may be safely undertaken, provided tacrolimus exposure is tightly monitored in patients. CONCLUSIONS: This strategy might represent an alternative to the immediate post-transplant introduction of ADVAGRAF and needs to be clinically validated in large-scale controlled trials.