*Purpose: Medication compliance remains a persistent, multifactorial problem in adolescent renal transplant recipients. Improving adherence in this patient demographic would benefit long-term patient and graft survival. In recent years, we have transitioned at-risk patients to once daily extended tacrolimus (daily dosing) to limit pill burden and increase adherence. We evaluated this patient cohort prior to and after their switch to daily dosing for rejection, graft function and graft survival.

*Methods: Fifteen patients identified at risk for non-adherence were transitioned to daily dosing. Rejection, graft function as measured by glomerular filtration rate (GFR) and 3-year graft survival were evaluated pre- and post-transition to daily dosing.

*Results: Patients underwent transplant from 2006-2016. The average age at transplant was 13.8 (8-21) and the average age at transition to daily dosing was 18.6 (15-22). Thirteen of 15 patients underwent induction with anti-thymocyte globulin (ATG); one patient underwent induction with daclizumab and one patient underwent induction with basiliximab owing to a reaction to ATG. Initial maintenance immunosuppression included twice daily tacrolimus and mycophenolate mofetil for all patients; 7/15 were steroid-free. Prior to transitioning to daily dosing, 10/15 patients developed at least one episode of rejection with eight of these patients having two or more episodes of rejection. The average GFR prior to daily dosing was 67.5 mL/min/1.73 m². Within one year of transition to daily dosing, only three patients had episodes of rejection; two of these patients had rejection prior to switching to daily dosing and the remaining patient did not have documented rejection prior to daily dosing. At three years, overall graft survival was 86.6%. Two patients lost their graft; one patient had two episodes of rejection prior to daily dosing; the graft failed secondary to chronic rejection and recurrence of primary disease. The second patient had ongoing rejection prior to switching to daily dosing that progressed to graft failure. Excluding the patients that progressed to graft failure, the average GFR on daily dosing was 77.7 mL/min/1.73 m². Ten of the 13 patients that did not experience graft loss actually demonstrated stable to improved graft function after the switch. There was no documented calcineurin inhibitor toxicity on daily dosing.

*Conclusions: Once daily extended-release tacrolimus offers an alternative for adolescent renal transplant recipients to improve adherence. Two patients did progress to graft failure; however, the remaining patients demonstrated fewer rejection episodes and a preserved GFR. While medication compliance is multifactorial, daily dosing of immunosuppression can be considered in this patient population.

« Back to 2020 American Transplant Congress