In:
Therapeutic Drug Monitoring, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 5 ( 2020-10), p. 671-678
Abstract:
Currently, the recommended tacrolimus (TAC) trough level (Cmin) after liver transplantation (LT) is 6–10 ng/mL (when associated in triple immunosuppressive therapy). However, few studies have achieved the lower limit of this range, especially below 7 ng/mL. This study evaluated the efficacy of a target TAC Cmin of 4–7 ng/mL after LT. Methods: Of 1677 LTs performed between 2002 and 2017, 904 LT cases were analyzed. The cases were categorized into the following 3 groups and compared: low- (n = 247, 27.3%), intermediate- (n = 344, 37.9%), and high-exposure groups (n = 313, 34.5%) with TAC Cmin of 4–7 ng/mL, 7–10 ng/mL, and 〉 10 ng/mL, respectively. In addition, propensity score matching was performed to reduce heterogeneity and population bias. Results: At months 1 and 3, when compared with the 2 other groups, the low-exposure group had similar grafts ( P = 0.75) and patient ( P = 0.77) survival, but lower alanine aminotransferase ( P 〈 0.001), bilirubin ( P 〈 0.001), international normalized ratio ( P = 0.046), and creatinine ( P 〈 0.001) levels. After propensity score matching, the bilirubin ( P 〈 0.001) and creatinine ( P = 0.001) levels in the low-exposure group still improved at months 3, but the graft ( P = 0.86) and patient ( P = 0.99) survival were still similar. Conclusions: A TAC Cmin of 4–7 ng/mL seems safe and capable of improving graft and kidney function. This finding should be confirmed in a prospective randomized trial.
Type of Medium:
Online Resource
ISSN:
0163-4356
DOI:
10.1097/FTD.0000000000000779
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2020
detail.hit.zdb_id:
2048919-5
SSG:
15,3
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