Evaluation of Different Initial Tacrolimus Dosing Regimens in Pediatric Post-Liver Transplantation
1Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia, 2Pharmaceutical Care, King Faisal Specialized Hospital and Research Center, Riyadh, Saudi Arabia
Meeting: 2022 American Transplant Congress
Abstract number: 1459
Keywords: Calcineurin, Liver, Pediatric, Weight
Topic: Clinical Science » Liver » 61 - Liver: Pediatrics
Session Information
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Tacrolimus is an immunosuppressant used in post-liver transplantation, has wide pharmacokinetic variability, particularly in pediatric patients. Therefore, this study aimed to evaluate different weight-based dose regimens required to achieve tacrolimus therapeutic target early post-liver-transplant as well as identify the factors affecting time needed to achieve therapeutic target to determine dosing regimen that can promptly achieve the target
*Methods: Ongoing multi-center retrospective study IRB was granted from 2 transplant centers. Patients included in the study if age < 18 years, underwent liver transplantation, and were on tacrolimus therapy. Tacrolimus was started with a fixed dose of 0.5 mg every 12 hours adjusted based on tacrolimus level to achieve therapeutic target level (7-12 ng/ml). Doses adjusted for body weight and serum levels were analyzed daily for the first two weeks post-transplant[Aa1] . Demographic variables and other patient’s specific factors known to affect dose requirements such as donor status, concurrent immunosuppressants, surrogate metabolism marker; concentration to dose ratio (C0/D ratio), surgery, and feeding details were collected. The primary outcome was to describe tacrolimus daily dose requirement needed to achieve therapeutic target in the first 2 weeks post-transplant. The secondary outcome is to identify factors affecting time needed to reach therapeutic tacrolimus level within first 2 weeks post-transplant
*Results: So far, 45 patients included in study 20 (44%) were female, mean age 4.29±4.42 years. The most common indication for liver transplantation were metabolic diseases (70%). Majority of patients (60% ) started on tacrolimus with a dose of < 0.1mg/kg/day mean of 0.07 ± 0.05 mg/kg/day. By the day that those patients were on target level only 30% remain on this dose range while 70% maintained on doses ³ 0.1mg/kg/day and, by day 14 this percentage further increased to 83% with a mean dose of 0.24 ±0.18 mg/kg/day. Eighty-two percent reach therapeutic target during the first 2 weeks. The average time needed to reach therapeutic is 5.92 ±2.55 days. When evaluating factors affecting time needed to reach the therapeutic level, C0/D ratio was significantly higher in patients reaching target level within 7 days compared to those who reach later in > 7 days p = 0.0020. Additionally, patients on interacting medications like caspofungin require significantly longer time reach therapeutic range when compared to those who are not p = 0.046
*Conclusions: Dose requirements appear to be higher than the usual starting tacrolimus dose in pediatric liver transplants during early phase post-transplantation. Multiple factors could affect the time needed to reach therapeutic range including tacrolimus metabolism and interacting medications
To cite this abstract in AMA style:
Alghanem AF, Alsmari A, Joharji H. Evaluation of Different Initial Tacrolimus Dosing Regimens in Pediatric Post-Liver Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-different-initial-tacrolimus-dosing-regimens-in-pediatric-post-liver-transplantation/. Accessed December 2, 2024.« Back to 2022 American Transplant Congress