Conversion From Twice-Daily to Once-Daily Tacrolimus Among Egyptian Living-Donor Kidney Allograft Recipients: A Single-Center Experience
| Autor: | Mohamed A. Bakr, Mohamed Hamed Abbas, Ahmed Farouk Donia, Ayman Maher Nagib |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Urology Renal function chemical and pharmacologic phenomena 030230 surgery Single Center Drug Administration Schedule Tacrolimus Medication Adherence 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Living Donors Medicine Humans Prospective Studies Prospective cohort study Kidney transplantation Transplantation Creatinine Kidney business.industry Immunosuppression medicine.disease Allografts Kidney Transplantation surgical procedures operative medicine.anatomical_structure Treatment Outcome chemistry Egypt business Immunosuppressive Agents |
| Zdroj: | Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 17(5) |
| ISSN: | 2146-8427 |
| Popis: | Objectives Adherence to immunosuppression and minimization of drug exposure are important con-siderations in preventing rejection and maximizing transplant outcomes. The once-daily tacrolimus protocol confers potential benefit by simplifying immunosuppressive regimens, thereby improving adherence among transplant recipients. Studies of stable transplant recipients have suggested that once-daily tacrolimus is bioequivalent to twice-daily tacrolimus and is noninferior to twice-daily tacrolimus with a concentration-dependent rejection risk. Our aim was to evaluate the safety and efficacy of conversion from twice-daily tacrolimus formulation to a once-daily formulation among a cohort of adult living related-donor renal transplant patients as a single-center experience. Materials and methods This prospective, one arm, single-center study included 238 patients with at least 12 months posttransplant follow-up and no rejection episodes in the last 3 months. Conversion from twice-daily to once-daily formulation was based on a 1:1 ratio. Results The mean tacrolimus dose was 4.7 ± 2.7 mg/day preconversion versus 4.9 ± 3.2 mg/day postconversion (P = .8). The mean tacrolimus level was 7.4 ± 3.4 versus 6.1 ± 2.8 ng/mL (P = .75). Of total patients, 45% were maintained on a tacrolimus dose of less than 2 ng/dL. Renal function was comparable before and after conversion (mean serum creatinine was 1.25 ± 0.88 vs 1.23 ± 0.78 mg/dL; P = .9). The incidence of biopsy-proven acute rejection was 19.7% preconversion versus 4.2% postconversion. Graft and patient survival rates were comparable between the 2 tacrolimus formulations. Once-daily tacrolimus also had favorable effects on blood pressure, lipid profile, and glucose tolerance. Conclusions Conversion from conventional tacrolimus (twice daily) to once-daily tacrolimus may be a valuable option with comparable patient and graft survival and may lead to improved adherence that may be reflective of better long-term results. It should be considered for de novo immunosuppression among living-donor renal allotransplant recipients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|