Tacrolimus time-in-therapeutic range is associated with freedom from acute rejection and graft failure following intestinal transplantation.

Autor: Santeusanio AD; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA.; Department of Pharmacy, Mount Sinai Hospital, New York, NY, USA., Gu A; Mount Sinai Hospital, New York, NY, USA., Weinberg AD; Department of Population Health Science and Policy, Mount Sinai Hospital, New York, NY, USA., Moon J; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA., Iyer KR; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2021 Jun; Vol. 35 (6), pp. e14291. Date of Electronic Publication: 2021 Apr 03.
DOI: 10.1111/ctr.14291
Abstrakt: Background: Trough-adjusted tacrolimus is commonly prescribed following intestinal transplantation to prevent allograft rejection. Despite established practice, there remains limited direct evidence linking tacrolimus levels with improved clinical outcomes.
Methods: This was a single-center review of all adult non-liver containing intestinal allograft recipients from 2011 to 2018. Patients received lymphocyte depleting induction and maintenance immunosuppression consisting of tacrolimus and a corticosteroid taper. Tacrolimus time-in-therapeutic range (TAC-TTR) was calculated for all patients from the date of transplant until 1-year post-transplant using Rosendaal's method. Cox-Proportional hazards modeling was utilized to assess freedom from acute rejection and graft failure stratified by TAC-TTR quartile.
Results: 47 patients were included in the review. Mean TAC-TTR for the cohort was 30.2% ± 11.4. Fifteen episodes of acute rejection were observed, 8 of which were severe. Patients in the highest TAC-TTR quartile >36% had a lower incidence of acute rejection and graft failure relative to patients with a TAC-TTR <20%. Cox-Proportional hazards modeling found a 10% decrease in TAC-TTR was associated with an increased hazard for acute rejection (2.03), severe acute rejection (2.19), and graft loss (3.33).
Conclusion: The results of this study suggest that decreasing TAC-TTR is a risk factor for both acute rejection as well as intestinal allograft failure.
(© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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