Use of Tacrolimus Extended-Release in Elderly Kidney Transplant Recipients
1Barnes-Jewish Hospital, Saint Louis, MO, 2Washington University, Saint Louis, MO
Meeting: 2020 American Transplant Congress
Abstract number: B-112
Keywords: Elderly patients, Immunosuppression, Kidney transplantation
Session Information
Date: Saturday, May 30, 2020
Session Name: Poster Session B: Kidney Immunosuppression: Novel Regimens and Drug Minimization
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Tacrolimus extended-release (LCPT) has been associated with efficacy and decreased rates of tremor when compared with tacrolimus immediate-release (Tac-IR) in kidney transplant recipients. Patients ≥ 65 years old are not well represented in previously published studies; the purpose of this study is to supplement existing literature of efficacy and safety of LCPT in elderly patients.
*Methods: We performed a retrospective, single center cohort analysis of adult kidney transplant recipients from 1/2015 to 6/2017 who received either Tac-IR or LCPT and remained on the same formulation for at least one year post-transplant. The primary outcome was a composite of graft loss, death, or biopsy-proven acute rejection (BPAR) at two years post-transplant; secondary outcomes included GFR and tremor differences. To determine if elderly patients have the same weight-based dose requirement to attain target trough level, LCPT dosing was compared between patients ≥ 65 and <65 years of age. Between group differences were evaluated using Chi-square and independent samples t-test where appropriate.
*Results: 89 kidney transplant patients aged 65 or older received either LCPT (n=52) or Tac-IR (n=37). Baseline characteristics were well matched between the two groups; the average age was 69.1 years in LCPT and 67.8 years in Tac-IR group (P=0.22). There were no differences in sex, race, type of induction, duration of dialysis, or type of donor between groups. The primary composite outcome of graft loss, death, or BPAR occurred in 15.4% of patients in the LCPT arm and 8.1% in the Tac-IR arm (P=0.30). Median GFR at two years post-transplant was 57.0 mL/min (IQR 49.2, 71.7) in LCPT patients compared with 57.0 mL/min (IQR 49.2, 71.7) in Tac-IR patients (P=0.68). There were no significant differences in tremor between groups. Comparison of weight based dosing in patients ≥65 and <65 years old revealed at all time points elderly patients required less tacrolimus as shown in Table 1.
| Age ≥65 (n=52) | Age <65 (n=176) | P-value | |
| 30 day mg/kg tacrolimus dose (mean ± SD) | 0.06 ± 0.03 | 0.08 ± 0.04 | <0.01 |
| 90 day mg/kg tacrolimus dose (mean ± SD) | 0.05 ± 0.03 | 0.06 ± 0.04 | 0.01 |
| 180 day mg/kg tacrolimus dose (mean ± SD) | 0.03 ± 0.02 | 0.06 ± 0.04 | <0.01 |
| 270 day mg/kg tacrolimus dose (mean ± SD) | 0.03 ± 0.02 | 0.05 ± 0.04 | <0.01 |
| 365 day mg/kg tacrolimus dose (mean ± SD) | 0.03 ± 0.02 | 0.05 ± 0.04 | <0.01 |
*Conclusions: Use of LCPT in elderly patients resulted in similar graft function and tremor in our population. Patients 65 years of age and older may require lower mg/kg doses of LCPT to attain therapeutic trough levels.
To cite this abstract in AMA style:
January S, Hagopian J, Nesselhauf N, Progar K, Santos RDelos. Use of Tacrolimus Extended-Release in Elderly Kidney Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/use-of-tacrolimus-extended-release-in-elderly-kidney-transplant-recipients/. Accessed March 8, 2021.« Back to 2020 American Transplant Congress