Purpose: We aimed to analyze the impact of FK levels at selected time points after KT on the evolution of graft function (based on estimated GFR by MDRD equation) during the first year of transplantation among recipients with DGF.
Methods: We reviewed all adult KT over a 10 year period. Only first time kidney transplant recipients (KTR) with DGF but no early biopsy-proven rejection (BPR) and on tacrolimus, Mycophenolate, and Prednisone at discharge were included. Kidney combined with other organ transplants were excluded. We analyzed the correlation of tacrolimus (FK) levels at days 7, 60, and 180 after KT with the change in MDRD-GFR (C-GFR) from each corresponding time point to 1 yr post transplant. Multivariate linear regression analysis (LRA) for factors affecting C-GFR was done.
Results: Between 7/2000 to 6/2011, there were 1,268 KTR in our center. 307 KTR had DGF and met the inclusion criteria. Mean recipient age was 40 yr., 53% were males and ,18% Blacks. 90% of grafts were from deceased donors. The cohort had a BPR rate within 1 yr of 9%, only 4% had PRA >20%, and 92% had > 3 HLA mismatches pre KT. Mean CIT and WIT were 22 hr. and 31 min., respectively.
Mean GFR at day 7 and 1 year after KT were: 18.5 ± 15.5 ml/min. and 50.4 ± 16.4 ml/min. Mean change in GFR over 1 yr. was 32 ± 21.0 ml/min. Mean FK levels (ng/ml) were : 11.1± 3.9 day 7, 9.8 ± 3.7 day 60, and 7.5± 2.8 day 180 after KT. Analysis (see fig.1) showed that the FK level at day 7 but not at days 60 and 180 is significantly correlated with C-CFR over 1 year. LRA showed that eGFR and FK level at day 7 both impacted C-GFR. Other factors that significantly impacted C-GFR were: BPR, donor and recipient age, and black KTR race. BP, CIT, and induction agent class were not significant.
Conclusion: For the population of adult KTR with DGF and no early BPR studied, FK level at day 7 but not at other follow up periods analyzed had a significant correlation with the change in GFR (from that time point to 1 year after KT). Factors with strongest negative association with C-GFR were : BPR, GFR at day 7, FK level at day 7, and donor age.
To cite this abstract in AMA style:Santos A, Wen X, Casey M, Zendejas I, Bucci C, Rehman S. Impact of Tacrolimus (FK) Level on Evolution of Graft Function in the First Year after Kidney Transplant (KT) among Recipients with DGF: A Ten Year Retrospective Analysis [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/impact-of-tacrolimus-fk-level-on-evolution-of-graft-function-in-the-first-year-after-kidney-transplant-kt-among-recipients-with-dgf-a-ten-year-retrospective-analysis/. Accessed February 26, 2020.
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