Introduction: The calcineurin inhibitor (CNI) tacrolimus is a very effective immunosuppressive drug after liver transplantation (LTx) but is often associated with an impaired renal function. This study analyses the impact of the tacrolimus metabolism rate on the renal function after LTx.
Methods: 268 patients underwent a LTx between January 2000 and March 2012 and received an initial immunosuppressive therapy with tacrolimus, mycophenolate mofetile and prednisolone. 6 months after LTx, patients were sectioned in two groups of tacrolimus metabolism rate: slow and fast metabolizers. The tacrolimus metabolism rate was expressed as the dose normalized by blood trough concentration (C/D ratio). The renal function was collected 6, 12 and 36 months after LTx using the estimated glomerular filtration rate (eGFR calculated by the Cockcroft-Gault formula).
Results: At the time of LTx there was no significant difference between the eGRF values of fast and slow metabolizers (81.58±40.25 vs. 94.05±57.49, p=0.18). In the course of the following months in the group of fast metabolizers significant lower eGFR values were found [75.64±32.42 vs. 89.10±34.86 (p=0.034) after 6 months, 70.64±33.63 vs. 87.29±35.44 (p=0.028) after 12 months]. There was a lower but not significantly lower eGFR value after 36 months in the group of fast metabolizers (80.09±39.00 vs. 84.70±31.13, p=0.67). Due to an assumed CNI nephrotoxicity 32.5% of fast metabolizers and 15.7% of slow metabolizers were switched from tacrolimus to another immunosuppressive drug during the first three years after LTx (p=0.016). There were no significant differences between complications like loss of liver function (p=0.62) and death (p=0.46) between the two groups.
Conclusion: The tacrolimus metabolism rate has a significant influence on the renal function after LTx. This analysis confirms that the C/D ratio is a suitable and simple clinical tool to define patients at risk of CNI nephrotoxicity.
To cite this abstract in AMA style:Thölking G, Siats L, Fortmann C, Beckebaum S, Cicinnati V, Gerth H, Wolters H, Anthoni C, Brockmann J, Pavenstädt H, Schmidt H, Suwelack B, Kabar I. Tacrolimus Metabolism Rate Influences the Kidney Function after Liver Transplantation, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/tacrolimus-metabolism-rate-influences-the-kidney-function-after-liver-transplantation-the/. Accessed January 17, 2018.
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