Nonadherence is one of the most important causes of late renal graft loss. A single daily dose of tacrolimus in the morning beginning immediately after the transplant can improve adherence and improve long-term results. There have been few studies on initiating a single daily dose of tacrolimus immediately after renal transplant. We present our experience with extended-release tacrolimus (once a day dose) in 153 consecutive renal transplants with a minimum follow-up of 1 year in 4 renal transplant groups: Expanded Criteria Donor (ECD), Standard Criteria Donor (SCD), Donation After Cardiac Death Donor (DCDD) and Living Donors (LD). Acute rejection incidence was very low in all the groups. SCD group showed the highest rejection rate because it had the most hyperimmunized subjects. There were no significant differences in tacrolimus levels (ng/ml) at 7 days (7.5 vs. 6.8,), at 1 month (11.9 vs. 11.2) or at 3 months (8.9 vs. 10.1), respectively, between patients with and without rejection. At 1 year, graft survival was 91% (death-uncensored), patient survival 95% and SCr 1.4±0.4 mg%. Cumulative incidence of new onset diabetes after transplantation was 19%. A total of 22% of the patients had an infection requiring hospitalization.
|ECD N=58||SCD N=52||DCDD, N=31||LD, N=12|
|Recipient age (yr)||71±6||46±12||46±12||42±15|
|Incidence of PRAmax >20%/>50% (%/%)||4% / 0%||33% / 17%||10% /0%||9% /0%|
|Mean PRA max/curret (%/%)||3/0,1||18/6||2/4||2/2|
|IS Quadruple Therapy with Thymo N(%)||1(2)||14 (27%)||0(0%)||1(8%)|
|IS Sequential with Thymo N(%)||0(0)||0(0)||31(100)||0(0)|
|Acute Rejection N (%)||5(8)||10(19)||2(6)||1(8)|
Extended-release tacrolimus (once a day dose) administered immediately after renal transplant in patients receiving a kidney from ECD, SCD, DCDD or LD is effective and safe, with very low rates of acute rejection, diabetes and severe infections and excellent graft and patient survival.
To cite this abstract in AMA style:Andrés A, Gonzalez E, Polanco N, Garcia-Puente L, Morales J, Molina M, Gutierrez-Solis E, Hernandez A, Sevillano A, Praga M. Extended-Release Tacrolimus Therapy Is Effective and Safe in De Novo Kidney Transplant Recipients from Living and Expanded, Standard, or after Cardiac Death Deceased Donors [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/extended-release-tacrolimus-therapy-is-effective-and-safe-in-de-novo-kidney-transplant-recipients-from-living-and-expanded-standard-or-after-cardiac-death-deceased-donors/. Accessed April 3, 2020.
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