Elisabet Størset1,2, Anders Åsberg1,3, Anders Hartmann1, Anna V Reisaeter1, Hallvard Holdaas1, Morten Skauby1, Stein Bergan3,4, Karsten Midtvedt5. 1. Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. 2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 3. School of Pharmacy, University of Oslo, Oslo, Norway. 4. Department of Pharmacology, Oslo University Hospital, Oslo, Norway. 5. Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. kmidtved@ous-hf.no.
Abstract
AIM: 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. CONCLUSION: Low-target tacrolimus-based immunosuppression is safe and effective also in a standard clinical setting in de novo standard risk renal transplant recipients.
AIM: 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. CONCLUSION: Low-target tacrolimus-based immunosuppression is safe and effective also in a standard clinical setting in de novo standard risk renal transplant recipients.
Authors: Iolanda Godinho; Maria João Melo; João Gonçalves; Marta Neves; Alice Santana; José Oliveira Guerra; António Gomes da Costa Journal: Transplant Direct Date: 2017-06-19
Authors: Kjersti Lønning; Kristian Heldal; Tomm Bernklev; Cathrine Brunborg; Marit Helen Andersen; Nanna von der Lippe; Anna Varberg Reisæter; Pål-Dag Line; Anders Hartmann; Karsten Midtvedt Journal: Transplant Direct Date: 2018-03-01