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KMID : 0371320100790060428
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Journal of the Korean Surgical Society
2010 Volume.79 No. 6 p.428 ~ p.435
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Optimized Tacrolimus Therapy in the Early Stage after Renal Transplantation
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Min Sang-Il
Kim Seong-Yup
Ahn Sang-Hyun
Jung Chin-Koo
Min Seung-Kee
Ha Jong-Won
Kim Sang-Joon
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Abstract
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Purpose: Immunosuppressive regimen based on reduced-dose Tacrolimus (TAC) is widely accepted in the field of renal transplantation. However, optimal targetsfor TAC whole blood trough concentrations during the early period after kidney transplantation remain uncertain.
Methods:A total of 184 consecutive adult renal transplant recipients with triple immunosuppression (TAC/Mycophenolate/corticosteroid) were included in this study. According to the trough level of TAC at day 7 after transplantation, patients were classified as low TAC concentration (LT, ＜10 ng/ml, n=85), intermediate TAC concentration (IT, 10∼15 ng/ml, n=75), and high TAC concentration (HT, ＞15 ng/ml, n=24) groups. Rate of acute rejection, graft function and side effects of TAC within 1 yr after transplantation were evaluated.
Results:There was no difference in trough concentrations of TAC at 2 weeks, 1 month, 3 months, 6 months and 12 months after transplantation among the three groups. Significantly higher incidence of acute rejection within 2 weeks after transplantation was observed in LT group compared with IT and HT groups (17.4%, 5.6% and 4.8%, respectively, P=0.037). HT patients showed significantly better estimated glomerular filtration rates until 6 months after transplantation than IT and LT patients (75.5±24.8 vs. 63.8±12.8 and 64.3±15.2 ml/min at 6 months, P=0.03). There was no significant difference in TAC toxicity in terms of post-transplant diabetes and renal toxicity.
Conclusions:Short-term high TAC exposure immediately after kidney transplantation may provide lower incidence of acute rejection and better restoration of graft function compared with low or intermediate TAC exposure.
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KEYWORD
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Kidney transplantation, Tacrolimus, Trough concentration, Acute rejection, Graft function
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