Background: Recent data suggests that variability in tacrolimus trough levels after lung transplant may be associated with poor long term graft outcomes. The purpose of this study was to evaluate the incidence of tacrolimus trough variability in the early post-operative period as well as its association with perioperative length of stay (LOS) and allograft injury in the first 90 days.

Methods: This was a retrospective cohort study of lung transplant recipients from 2011-2015 at a large academic institution. Tacrolimus trough variability was defined as the standard deviation (SD) of all tacrolimus troughs in a given patient from post-operative days (POD) 8 to 45. This time period was chosen to reflect the expected time to achieve steady state after new initiation of therapy. Graft injury was defined by the presence of organizing pneumonia, diffuse alveolar damage, or any grade acute cellular rejection present on biopsy. Logistic and linear regression analyses were used to evaluate the association between either tacrolimus troughs or tacrolimus trough variability and the specified outcome variables.

Results: A total of 77 patients were included. On average, patients were 51 years old, 51% male, and 83% Caucasian. Upon discharge, 72 patients (93.5%) were taking mycophenolate and 77 patients (100%) were taking prednisone. There was evidence of graft injury in 13 patients (17%) in the first 90 days. The overall mean tacrolimus trough for all patients from POD 8-45 was 10.98±2.2ng/mL, the mean tacrolimus trough SD for all patients from POD 8-45 was 3.54±1.65ng/mL and the mean LOS for all patients was 29.2±38.5 days. There was no association found between mean tacrolimus trough or tacrolimus trough SD and graft injury at 90 days or hospital LOS (Table 1).

Conclusions: Early tacrolimus trough variability, specifically within the first 45 days of transplant, is not associated with biopsy-defined graft dysfunction in the early post-operative period. Further studies may be warranted to examine whether tacrolimus variability is associated with other comorbidities or manifestations of allograft injury.

CITATION INFORMATION: Boyle K, Moranville M, Shah P. Effect of Early Tacrolimus Trough Variability on Graft Outcomes in Lung Transplantation. Am J Transplant. 2016;16 (suppl 3).

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