Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Reaching a therapeutic tacrolimus (TAC) trough early post-kidney transplant is important in minimizing the risk of acute rejection. The aim of this study was to investigate whether using a weight based (WB) dosing strategy of 0.08 to 0.15 mg/kg/day leads to achieving therapeutic TAC (≥8ng/ml) troughs earlier than using a non-weight based (NWB) strategy in kidney transplant recipients (KTR).
*Methods: This was a retrospective single-center study of adult KTR from 7/2017 to 7/2018 who received de novo TAC. KTR were excluded if they received a strong CYP3A4 inhibitor or inducer at the time of TAC initiation, had length of stay exceeding 7 days, or had graft loss or death within 3 months post-transplant.
*Results: A total of 178 KTR were included. Baseline characteristics were not significantly different with the exceptions of the median admission weight (kg) being higher (90.2 IQR: [75,106.3] vs. 84.3 IQR: [70, 98.2], p=0.0216) and the median cumulative r-ATG dose (mg/kg) being lower (4.6 IQR: [4, 5.2] vs. 5.1 IQR: [5, 5.6], p=0.0011) in the NWB group. Compared to NWB, patients in the WB group required fewer days to achieve a therapeutic TAC trough (median [IQR]: 5 [2, 8] vs. 9 [5, 14], p <0 .0001) Figure 1. The WB group was more likely to have a therapeutic TAC trough at discharge (40% vs 20%, p=0.0045). Median eGFR (ml/min) at 3 months was higher in the WB (53 IQR: [46, 60]) compared to NWB group (47 IQR: [39, 60], p=0.0197). No significant difference was found in incidence of acute rejection or development of de novo donor specific antibody by 3 months. The incidence of delayed graft function (DGF) and frequency of supratherapeutic TAC troughs (≥15ng/ml) within the first 2 weeks were also similar between the two groups.
*Conclusions: Tacrolimus weight based therapy, using a dose of 0.08-0.15 mg/kg, appears to provide the benefit of achieving therapeutic TAC troughs early without increasing the risk for DGF or supratherapeutic TAC troughs. Given the well-established association between low TAC troughs and risk for acute rejection, we recommend adopting a weight based over a non-weight-based dosing strategy.
To cite this abstract in AMA style:Chunduru M, Schnelle K, Zhao S, Wei L, Daloul R. Time to First Therapeutic Tacrolimus Trough in Kidney Transplant Recipients: A Comparison of a Weight Based versus a Non-Weight Based Dosing Strategy [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/time-to-first-therapeutic-tacrolimus-trough-in-kidney-transplant-recipients-a-comparison-of-a-weight-based-versus-a-non-weight-based-dosing-strategy/. Accessed July 7, 2020.
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