Improved Kidney Function Post Lung Transplant with Intravenous Tacrolimus Avoidance
1Pharmacy, UC San Diego Health, San Diego, CA, 2Pulmonology, UC San Diego Health, San Diego, CA, 3Cardiothoracic Surgery, UC San Diego Health, San Diego, CA
Meeting: 2020 American Transplant Congress
Abstract number: C-312
Keywords: Immunosuppression, Lung transplantation, Renal dysfunction, Renal injury
Session Information
Session Name: Poster Session C: Lung: All Topics
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Tacrolimus (TAC) poses a dose-dependent risk of acute kidney injury (AKI) as well as chronic kidney disease (CKD) post-transplant. In 2017, our institution’s lung transplant (LT) protocol changed from using IV TAC to enteral TAC perioperatively. The purpose of this study is to evaluate AKI and CKD rates among LT recipients (LTRs) administered enteral TAC compared to IV TAC in the immediate post-LT period.
*Methods: We performed a single-center retrospective study of LTRs from 4/13/11 – 4/30/19. Daily SCr was used to determine AKI rate and severity (KDIGO) within the first 14 days post-LT. SCr was assessed at baseline, 30, 60, 90, 180 days and at 1 year post-LT to determine CKD rates and stages (KDIGO). Daily TAC whole blood concentrations (CONCs) were collected and defined as supratherapeutic if >25 ng/mL for IV and >15 ng/mL as a 12-hour trough for enteral TAC. Descriptive statistics were used to summarize data for both groups. Chi-squared and Fisher’s exact tests were used to compare categorical data between groups. Student’s t-test was used to compare continuous data between groups.
*Results: 152 patients were included; 110 (72.4%) started IV TAC and 42 (27.6%) on enteral TAC postoperatively. Data on 102 patients was included in the one-year analysis. Patient baseline characteristics are shown in Table 1 and study results in Table 2.
*Conclusions: The rate and severity of AKI was lower in LTRs who received enteral TAC compared to IV TAC. However, no difference was observed in the rate of CKD at 1 year post transplant between the groups. LTRs who received IV TAC had more days of supratherapeutic TAC CONCs. Among patients who had supratherapeutic TAC CONCs, there were fewer days of supratherapeutic TAC in those who developed AKI, likely influenced by the clinicians’ decisions to more liberally reduce TAC dosages in LTRs with AKI. In our study, IV TAC avoidance reduced overall AKI rates and severity perioperatively, but the long-term effect on renal function remains unclear.
| IV TAC (n=110) | Enteral TAC (n=42) | |
| Mean age, y (IQR) | 51 (38-64) | 53 (43-64) |
| Male, n (%) | 69 (62.7) | 23 (54.8) |
| Mean baseline SCr (mg/dL) +/- stdev | 0.78 +/- 0.28 | 0.86 +/- 0.25 |
| Primary underlying diagnosis, n (%) ILD COPD CF PH Other |
56 (50.9) 18 (16.4) 24 (21.8) 9 (8.2) 3 (2.7) |
26 (61.9) 5 (11.9) 4 (9.5) 6 (14.2) 1 (2.4) |
| IV TAC | Enteral TAC | p Value | |
| AKI POD 0-14, n (%) | 85/110 (77.3) | 21/42 (50) | 0.0021 |
| AKI Severity AKIN Grade I, n (%) AKIN Grade II, n (%) AKIN Grade III n, (%) |
27 (31.8) 37 (43.5) 21 (24.7) |
13 (61.9) 5 (23.8) 3 (14.3) |
0.0039 |
| Renal replacement therapy required POD 0-14 n (%) | 14/85 (16.5) | 3/21 (14.3) | 1.0 |
| Mean days supratherapeutic TAC, n AKI No AKI |
3.57 3.31 4.48 |
0.95 0.74 1.1 |
<0.001 |
| AKI with progression to CKD > Stage III at 1 y, n (%) | 25/83 (30.1) | 7/19 (36.8) | 1.0 |
| Total CKD > Stage III at 1 y, n (%) | 30/83 (36.1) | 11/19 (57.9) | 1.0 |
To cite this abstract in AMA style:
Burt C, Feist A, Afshar K, Awdishu L, Mariski M, Kozuch J, Yung G, Golts E. Improved Kidney Function Post Lung Transplant with Intravenous Tacrolimus Avoidance [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/improved-kidney-function-post-lung-transplant-with-intravenous-tacrolimus-avoidance/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress