*Purpose: The goal of this study was to assess the impact of African American (AA) race on the conversion ratio from Tac-IR to LCP-Tac, while also assessing clinical and PK outcomes in AA converted to LCP-Tac in kidney transplantation (KTX).

*Methods: This was a retrospective cohort study including KTX converted from Tac-IR to LCP-Tac between June 2019 through Oct 2020 with follow up through Nov 2021. Patients were excluded if they converted back to Tac-IR within one month of conversion to LCP-Tac or were never actually converted. Clinical and tac PK data was collected for the year before and after conversion, including all tacrolimus levels, all dose adjustment, toxicities, rates of infection, rejection graft loss and death.

*Results: 337 patients were initially screened; 45 patients were excluded and 292 patients were included; 189 patients were AA (64.7%) and 107 were non-AA. AA KTX were younger at time of KTX (age 51.1 vs 55.9), and more likely to receive a deceased donor. AAs had a longer time to reach steady state (54 vs 35 days; p 0.011) and required a higher dose LCP-Tac when normalized for a tacrolimus level of 6-10 ng/mL (0.094 vs 0.044 mg/kg; p <0.001). Conversion ratios between AA vs Non-AA were not statistically significant when normalized for goal of 6-10 ng/mL (0.77 vs 0.71; p 0.110). AAs had fewer tacrolimus levels and changes made off these levels. Rates of overall infection, hospital visits and rejection were similar between group. AAs continued to have significantly less neurotoxicity events after conversion (9.2% vs 19.6%; p 0.018).

*Conclusions: On average, AAs require higher doses of LCP-Tac to obtain therapeutic tacrolimus levels, but this did not result in a significant difference in conversion ratios between groups. It took AAs a longer time to reach steady state when transitioned from Tac-IR to LCP-Tac while having less tacrolimus levels drawn.

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