Impact of Once-Daily Tacrolimus on Adherence in Stable Adolescent and Young Adult Renal Transplant Recipients
M. Moss,1 J. Goebel,2 M. Bock.2
1Pharmacy, Children's Hospital Colorado, Aurora, CO
2Pediatric Nephrology, Children's Hospital Colorado, Aurora, CO.
Meeting: 2018 American Transplant Congress
Abstract number: B229
Keywords: Immunosuppression, Kidney transplantation, Pediatric, Psychosocial
Session Information
Session Name: Poster Session B: Kidney: Pediatrics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
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.
RTR (n) | 11 |
Male | 8 |
Caucasian | 6 |
Azathioprine (Aza) | 10 |
Median Age (yrs) at conversion (IQR) | 17 (15) |
Mean time (yrs) post-RT at conversion (SD) | 3.9 (3.6) |
Mean eGFR (mL/min/m2) (SD) | |
At conversion | 67.4 (25.6) |
30 days post-conversion | 67.7 (22.6) |
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).
To cite this abstract in AMA style:
Moss M, Goebel J, Bock M. Impact of Once-Daily Tacrolimus on Adherence in Stable Adolescent and Young Adult Renal Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/impact-of-once-daily-tacrolimus-on-adherence-in-stable-adolescent-and-young-adult-renal-transplant-recipients/. Accessed October 11, 2024.« Back to 2018 American Transplant Congress