Long-Term Effects of Monotherapy with Low Dose Tacrolimus
| Autor: | Jignesh Patel, Jon A. Kobashigawa, T. Singer-Englar, Antoine Hage, Evan P. Kransdorf, G. Jamero, D. Megna, M. Froch, N. Patel, Michelle M. Kittleson, Lawrence S.C. Czer |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Heart transplantation Transplantation medicine.medical_specialty Ejection fraction Leukopenia business.industry medicine.medical_treatment Urology chemical and pharmacologic phenomena Immunosuppression medicine.disease Tacrolimus Therapeutic index Conventional PCI medicine Surgery medicine.symptom Cardiology and Cardiovascular Medicine business Stroke |
| Zdroj: | The Journal of Heart and Lung Transplantation. 40:S133-S134 |
| ISSN: | 1053-2498 |
| Popis: | Purpose Monotherapy with tacrolimus alone (TAC-A) was found to be safe and effective in the TICTAC Trial. However, in that trial, tacrolimus levels were maintained at 10-12 ng/mL over the first year which resulted in a higher serum creatinine level compared to those left in combination. We have been using TAC-A at lower doses in patients who have developed leukopenia or thrombocytopenia due to immunosuppression or a natural state. The presence of cytomegalovirus infections and other viruses excluded those patients from being administered monotherapy. It has not been established whether low dose TAC-A is safe and effective. Methods Between 2010 and 2017 we assessed 151 heart transplant patients who are maintained on monotherapy with TAC-A. Patients were maintained on a low level of TAC-A between 4-7 ng/ml. These patients were assessed for subsequent 1-year rejection, subsequent 3-year survival, 3-year freedom from non-fatal major adverse cardiac events (NF-MACE: MI, new CHF, PCI, ICD implant, stroke), cardiac allograft vasculopathy (CAV, epicardial disease with angiographic stenosis>30%), and cardiac dysfunction (LVEF ≤ 40%). Furthermore, periodic testing was done with the T-cell immune function test to assess whether these patients were adequately immunosuppressed. Results Patients who were maintained on TAC-A had comparable outcomes compared to patients left in combination immunosuppression (see table). The T-cell immune function test showed that these patients had adequate immunosuppression (average was 276 ng/mL with a range of 56-794 ng/mL and standard deviation of 137.1 ng/mL) with the therapeutic range being 200-550ng/ml. Patients had an average of 11 Tacrolimus lab tests (range: 4-46). Conclusion Low dose TAC-A appears safe and effective in select patients after heart transplantation guided by T cell immune function testing. Further studies with larger number of patients will be needed to confirm these findings. |
| Databáze: | OpenAIRE |
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