Extended release once daily tacrolimus (LCP-Tacro) has demonstrated non inferiority to immediate release twice daily tacrolimus (IR-Tac) in kidney transplantation. These data are limited by clinical trial experience where the behavior of patients and management by clinicians are conducted in a controlled environment which seldom mirrors everyday clinical practice. Our practice is unique in its predominance of African American demographic. To broaden our understanding of the role for LCP-Tacro in clinical practice, this study was undertaken to identify reasons for converting from IR-TAC to LCP-Tacro and the time to achieve targeted tacrolimus (TAC) trough concentrations post-conversion in a high risk kidney transplant population.

A total of 186 kidney and kidney pancreas transplants were performed at our institution between January 1, 2014 and July 31, 2017. Eighteen patients met inclusion criteria (15 kidney alone, 3 SPK). Only patients receiving TAC in combination with mycophenolic acid with or without corticosteroids maintenance therapy were included.

Mean age at transplantation was 52 ± 17 years. A majority (61%) were male recipients. Deceased donation versus living donor source was 89% compared to 11%, respectively. African Americans made up 83% of the cohort. Rationale for converting from IR-TAC to LCP-Tacro was: nonadherence 28%, tremors 22%, difficulty achieving TAC trough levels 22% and headache 17%. Mean pre-conversion IR-TAC total daily dose was 12 ± 7.5mg. Mean conversion ratio was 0.87:1 (mg:mg) LCP-Tac: IR-Tac. 56% of the cohort achieved targeted TAC trough concentrations within 2 weeks post-conversion. There were no rejection episodes during the study period.

Our findings suggest that in our cohort of predominantly African Americans the most common reasons for converting from IR-Tac to LCP-Tac were nonadherence, tremors and the concern for stable drug concentrations post-transplant. Conversion was achieved without any episodes of rejection. More research is needed in this cohort to identify additional factors that could impact drug dosing and optimize the balance between immunosuppression and rejection.

CITATION INFORMATION: Benincasa M., Colomy V., Sifontis N., Rao S., Lau K., Karhadkar S., Di Carlo A., Diamond A. Conversion from Twice Daily Immediate Release Tacrolimus to Once Daily Extended Release Tacrolimus (LCP-Tacro) in High Risk Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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