Patients with ESRD Due to Diabetes Have Higher Variability of Their Tacrolimus Levels and Worse Outcomes.
Imperial College Renal and Transplant Centre, Imperial College NHS Trust, London, United Kingdom.
Meeting: 2016 American Transplant Congress
Abstract number: C273
Keywords: Graft survival, Immunosuppression, Kidney transplantation, Pharmacokinetics
Session Information
Session Name: Poster Session C: Poster Session 1: Kidney Complications-Other
Session Type: Poster Session
Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction
Nonadherence to immunosuppressants is associated with rejection and graft loss and nonadherence to antidiabetics is associated with poor glycaemic control leading to microvascular complications and mortality. We have previously shown that intrapatient variability (IPV) of tacrolimus levels can be used as a surrogate marker for adherence and that a high IPV can predict rejection and graft loss. In this study, we investigate the association between IPV of tacrolimus levels and transplant outcomes in a group of patients with ESRD caused by diabetes mellitus (DM).
Method
We retrospectively analysed 668 patients who received a low risk kidney only transplant between 2005 and 2013. Patients who were defined as reaching ESRD due to DM (biopsy and non-biopsy proven) were compared to patients with non-DM aetiology of ESRD who were not diabetic and did not develop NODAT. Patients with DM who were classified as having 'unknown cause of ESRD' or ESRD of other aetiology were excluded. All patients received alemtuzumab induction and tacrolimus monotherapy with a steroid sparing protocol and target tacrolimus level of 5-8ng/ml.
Results
105 patients were identified as having ESRD secondary to DM. 446 patients were used as controls. 117 patients were excluded. The mean HbA1c was 8.19±1.20. Mean follow up 5.65±2.12years
| DM | Non-DM | p value | |
| IPV 6-12 months | 19.56(14.97-27.68) | 17.66(12.85-24.21) | 0.0077 |
| Proportion in HV group | 63(60%) | 213(47.8%) | 0.0317 |
| IPV all levels after 6 months | 25.79(21.38-33.98) | 22.39(17.1-29.62) | 0.0008 |
| Mean tacrolimus 6-12months | 7.31(6.38-8.15) | 6.87(6.05-7.67) | 0.006 |
| Mean Max tacrolimus 6-12months | 9.9(8.1-11.1) | 8.8(7.6-10.4) | 0.0025 |
| Mean Min tacrolimus 6-12months | 5.1(4.38-6.2) | 5.1(4.2-5.9) | 0.69 |
| Overall patient survival | 65.6% | 92.6% | p<0.0001 |
| Overall DWFG survival | 72.7% | 93.2% | p=0.0004 |
| Overall censored graft survival | 71.2% | 90.6% | p=0.012 |
| Overall DSA free survival | 72.3% | 79.5% | p=0.013 |
Conclusion
This study shows that patients defined as having ESRD due to DM have a higher variability of their tacrolimus levels and worse outcomes compared to patients who have ESRD resulting from other causes. Whether the inferior outcomes can be attributed to poor adherence with medication, other co-morbidities or to changes in the pharmacokinetics and pharmacodynamics of medications that occur in patients with diabetes requires further exploration.
CITATION INFORMATION: Goodall D, Willicombe M, McLean A, Taube D. Patients with ESRD Due to Diabetes Have Higher Variability of Their Tacrolimus Levels and Worse Outcomes. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Goodall D, Willicombe M, McLean A, Taube D. Patients with ESRD Due to Diabetes Have Higher Variability of Their Tacrolimus Levels and Worse Outcomes. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/patients-with-esrd-due-to-diabetes-have-higher-variability-of-their-tacrolimus-levels-and-worse-outcomes/. Accessed May 9, 2025.« Back to 2016 American Transplant Congress