Purpose: Appropriate time to therapeutic immunosuppression levels is not well defined. The purpose of this study is to investigate outcomes related to time to therapeutic tacrolimus level (TTL) after heart transplantation.

Methods: Heart transplant (HT) recipients from Jan 1, 2000 to Oct 2, 2016, at a single center, who received tacrolimus and induction therapy, were included. Tacrolimus levels post-HT were analyzed for the time to first TTL (> 10 ng/mL for basiliximab and anti-thymocyte globulin (ATG) and > 8 ng/mL for alemtuzumab), renal function at 30 days, and freedom from first acute cellular rejection.

Results: A total of 466 patients who received induction; basiliximab (n=133), ATG (n=69), and alemtuzumab (n=264) were included. Survival at 12 months in each group was 85.2%, 75.4%, and 88.5% (p=0.07). Recipients were 54 years old, 89% were white, and 74% male. Median days to TTL were 5 for basiliximab, 8 for ATG, and 8 for alemtuzumab. Median days to TTL for those with and without rejection at 1 year were 8 v 11 days (p=0.01) for alemtuzumab, but not different for ATG (8 v 8) or basiliximab (5 v 6). Freedom from rejection at 1 year was not different for those above and below the median TTL, see figure. In subjects who received basiliximab, their mean baseline SCr was not different, between those above and below the median TTL (1.38 v 1.53 mg/dL, p=0.27). At 30 days, the change from baseline SCr was an increase of 0.28 mg/dL compared to a decrease of 0.14 mg/dL (p=0.052).

Conclusions: An increased time to TTL was not associated with an increased risk of rejection nor did it alter renal function.

CITATION INFORMATION: Witkowsky O, Teuteberg J, Sciortino C, Shullo M. Time to First Therapeutic Tacrolimus Level: What Impact Does It Have After Heart Transplantation? Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress