High Intrapatient Variability of Tacrolimus Concentrations Predicts Accelerated Progression of Chronic Histologic Lesions in Renal Recipients
| Autor: | Thomas Vanhove, Tim Vermeulen, Dirk Kuypers, Pieter Annaert, Evelyne Lerut |
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| Rok vydání: | 2016 |
| Předmět: |
Graft Rejection
Male Pathology medicine.medical_specialty 030232 urology & nephrology Renal function 030230 surgery Kidney Function Tests Gastroenterology Tacrolimus 03 medical and health sciences 0302 clinical medicine Risk Factors Fibrosis Internal medicine medicine Humans Transplantation Homologous Immunology and Allergy Pharmacology (medical) Retrospective Studies Subclinical infection Transplantation business.industry Graft Survival Odds ratio Middle Aged Prognosis medicine.disease Kidney Transplantation Confidence interval Cohort Disease Progression Kidney Failure Chronic Female Atrophy business Immunosuppressive Agents Follow-Up Studies Glomerular Filtration Rate |
| Zdroj: | American Journal of Transplantation. 16:2954-2963 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.13803 |
| Popis: | High intrapatient variability (IPV) of tacrolimus concentrations is increasingly recognized as a predictor of poor outcome in solid organ recipients. How it relates to evolution of histology has not been explored. We analyzed tacrolimus IPV using the coefficient of variability (CV) from months 6-12 after transplantation in a cohort of 220 renal recipients for whom paired protocol biopsies at 3 mo and 2 years were available. Recipients in the highest CV tertile had an increased risk of moderate to severe fibrosis and tubular atrophy by 2 years compared with the low-IPV tertile (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.09-5.60, p = 0.031; and OR 2.40, 95% CI 1.03-5.60, p = 0.043, respectively). Other predictors were donor age, severity of chronic lesions at 3 mo, and presence of borderline or subclinical rejection at 3 mo. Chronicity score increased significantly more in the high CV tertile group than in the middle and low tertiles (mean increase 1.97 ± 2.03 vs. 1.18 ± 2.44 and 1.12 ± 1.80, respectively; p < 0.05). CV did not predict evolution of renal function, which did not deteriorate within the 2-year follow-up period. These results indicate that high IPV is related to accelerated progression of chronic histologic lesions before any evidence of renal dysfunction. |
| Databáze: | OpenAIRE |
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