Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: The optimal initial dose for tacrolimus (TAC) after renal transplant (RT) remains controversial with limited evidence comparing weight-based and conservative strategies. Recent literature suggests that a weight-based approach reduces days to therapeutic TAC levels and biopsy-proven acute rejection (BPAR) incidence without affecting glomerular filtration rate (GFR). This study aims to evaluate the time to therapeutic TAC level following primary RT with a conservative dosing model at our institution.
*Methods: This single-center study included recipients of primary RT at UAB Hospital between July 31, 2016, and July 31, 2017. The primary outcome was time to therapeutic TAC trough level. Secondary outcomes included inpatient length of stay (LOS), GFR and incidence of BPAR at 12 months post-transplant.
*Results: A total of 144 patients were included and stratified into four patient groups based on TAC dose to weight ratios. Patients with the highest dose to weight ratio (Group 4) reached serum TAC trough ≥8 ng/mL in significantly fewer days compared to other groups (7.1 ± 3.7 days vs. 10.9 ± 6.7 days, 9.6 ± 4.1 days, and 8.8 ± 3.5 days for Groups 1, 2, and 3 respectively, P = 0.0054). There was no difference in LOS (6.6 ± 2.3 days for Group 1, 7.4 ± 2.6 days for Group 2, 6.9 ± 2.3 days for Group 3, and 6.4 ± 2.2 days for Group 4, P = 0.1392) or GFR (mL/min/1.73 m2) at 12 months (55.8 ± 17.9 for Group 1, 52.5 ± 13.1 for Group 2, 63.2 ± 21.2 for Group 3, and 56.8 ± 19.0 for Group 4, P = 0.3395). Patients in the group with the lowest dose to weight ratio (Group 1) experienced a numerically higher incidence of BPAR at 12 months compared to other groups (15.8% vs. 2.7%, 3.0%, and 2.8% for Groups 2, 3, and 4 respectively, P = 0.0858).
*Conclusions: Patients initiated on TAC at a higher dose to weight ratio reached therapeutic trough levels in fewer days with no difference in GFR at 12-months compared to a lower dose to weight ratio. The dose to weight ratio did not significantly affect the LOS following renal transplantation or the incidence of BPAR at 12 months.
To cite this abstract in AMA style:Banbury J, Dodson A, Lin C, Gutierrez K. Assessment of Time to Therapeutic Tacrolimus Levels Following Renal Transplantation in a Non-Weight-Based Dosing Model [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/assessment-of-time-to-therapeutic-tacrolimus-levels-following-renal-transplantation-in-a-non-weight-based-dosing-model/. Accessed October 31, 2020.
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