Early outcomes associated with de novo once-daily extended-release versus twice-daily immediate-release tacrolimus in a predominantly African American kidney transplant population: A single-center observational study.

Autor: Romine MM; Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA., Leeser DB; Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA., Kennamer K; Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA., Nguyen C; East Carolina University Health System, Greenville, North Carolina, USA., Jones H; Eastern Nephrology Associates, Greenville, North Carolina, USA., McLawhorn K; Eastern Nephrology Associates, Greenville, North Carolina, USA., Kendrick S; Eastern Nephrology Associates, Greenville, North Carolina, USA., Irish W; Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Mar; Vol. 38 (3), pp. e15268.
DOI: 10.1111/ctr.15268
Abstrakt: Introduction: The purpose of this study was to compare early outcomes of de novo LCPT (once-daily extended-release tacrolimus) to IR TAC (twice-daily immediate-release tacrolimus) in a predominantly African American (AA) adult kidney transplant population.
Methods: This is a single center, retrospective cohort study. Patients were divided into two cohorts: IR TAC (administered between January 1, 2017, and January 31, 2019) and LCPT (administered between February 1, 2019, and May 31, 2020). Primary endpoints were changes in tacrolimus trough levels (ng/mL) and estimated glomerular filtration rate up to 12 months post-transplantation. Clinical endpoints included graft survival, delayed graft function, biopsy-proven rejection, CMV viremia, and BK. A propensity score weighted generalized linear mixed effects model was used for analysis.
Results: The rate of change in tacrolimus levels was significantly higher in the LCPT cohort compared to the IR TAC cohort at 14 days post-discharge (.2455 ng/mL per day vs. .1073 ng/mL, respectively; p < .001). Subsequently, the LCPT cohort had a slightly higher rate of decline (-.015 ng/mL per day vs. -.010 ng/mL with IR TAC; p = .0894) up to 12 months post-discharge. Although eGFR was similar between the two cohorts at 12 months post-transplant, the rate of increase was slower in the LCPT cohort (.1371 mL/min per day vs. .1852 mL/min per day, p = .0314). No significant differences were found in graft survival, DGF, BPAR, CMV, or BK infection.
Conclusion: This study demonstrates that despite higher early trough levels with immediate post-transplant LCPT use, clinical outcomes are comparable to IR TAC at one-year post-transplant. Notably, LCPT use does not increase the incidence of DGF and that this formulation of CNI can be used as first line therapy post-transplant.
(© 2024 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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