Medication non-adherence is a risk factor for graft dysfunction and loss among renal transplant recipients (RTRs), especially adolescents and young adults (AYA). Number of medication doses per day is a risk factor known to impact adherence. We evaluated the impact of conversion from twice-daily tacrolimus (Tac) to once-daily Tac (Astagraf®) in AYA RTRs on medication adherence (assessed by variation in Tac trough concentrations, Vtac).

We studied 11 stable AYA RTRs (≥13 y) converted from twice-daily Tac to once-daily sustained-release Tac. Subjects were matched for age, race, gender, and time post-RT with controls remaining on twice-daily Tac. Maintenance immunosuppression consisted of Tac, antiproliferative therapy and corticosteroids. Adherence was assessed by measuring Vtac pre- and post-conversion.

In stable AYA RTRs, Vtac improved following conversion to once-daily Tac as evidenced by a narrowing standard deviation of Tac trough concentrations (2.63 vs. 1.25, p = 0.023). Post-conversion trough concentrations were lower than those observed with twice-daily Tac (5.43 ng/mL vs. 6.7 ng/mL, p = 0.021). To achieve target Tac concentrations, a median dose conversion of 1:1.25 was required when converting to once-daily Tac. Renal function (eGFR) remained stable 30 days following conversion (p = 0.885).

Compared to twice-daily matched controls, study patients selected for once-daily Tac demonstrated wider Vtac prior to conversion (SD 1.14 vs 2.51, p = 0.009). Following conversion this difference diminished (1.14 vs 1.34, p = 0.621). The majority of patients converted to once-daily Tac received Aza (p < 0.001), consistent with our goal of offering once-daily immunosuppression to AYA RTRs at high risk for non-adherence.

We conclude that Vtac is improved with conversion to once-daily sustained release Tac, in combination with Aza, in AYA RTRs demonstrating non-adherence on a twice-daily Tac regimen. Therefore, in this at-risk population, once daily dosing appears to improve adherence. Furthermore, such conversion does not appear to put graft function at risk.

CITATION INFORMATION: Moss M., Goebel J., Bock M. Impact of Once-Daily Tacrolimus on Adherence in Stable Adolescent and Young Adult Renal Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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