Purpose

Tacrolimus is one of the most frequently used immunosuppressants in pediatric kidney transplantation (KT) as in adult. In Pediatric kidney recipients, it is more important to improve medical adherence and to overcome calcineurin inhibitor toxicity, because they are usually required longer time use of immunosuppressants than adult recipients. Advagraf is new tacrolimus agent for once-daily formulation to improve compliance of patients. This study aimed to identify long-term results after conversion from traditional twice-daily tacrolimus to the once-daily tacrolimus in pediatric KT.

Methods

Between July 2011 and January 2012, 34 pediatric KT recipients who received were converted at mean post-transplant period of 1221 ± 675 days (previously reported in Am J Transplant 2013). They were followed up to last days of mean 1130 ± 92 days after conversion. The patients were checked physical examination and laboratory findings including body mass index (BMI), glomerular filtration rate (GFR), Tacrolimus dose and trough level.

Results

Mean age of patients at conversion was 12.3 ± 2.8. Three patients ceased their Advagraf use. Of them, one patient received chemotherapy for Burkitt lymphoma and maintained corticosteroid only, and two patients were re-converted to twice-daily dosing tacrolimus by failing to maintain appropriate trough level of tacrolimus. There was no significant factor that effected on the re-conversion. Adverse effects including one acute T cell mediated rejection and six infectious disease developed in period after 6 months. BMI (1, 2 year after conversion, p=0.014, 0.029), second year GFR (p=0.033) and last trough level of tacrolimus (p=0.038) were risk factors on the adverse effects after conversion. Donor age at transplantation (p=0.008) and recipient age at conversion to advagraf (p=0.029) had negative correlation to GFR at last follow-up. Trough level of tacrolimus at last follow-up was effected by Donor age at transplantation (p=0.028).

Conclusion

Weight control and donor age at transplantation are important to maintain stable transplanted kidney function. Once daily tacrolimus formulation can be safely used in pediatric patients despite of changes in dose and tacrolimus pharmacokinetics.

« Back to 2015 American Transplant Congress