Tacrolimus trough level impact on Graft Rejection and Glomerular Filtration Rate in Patients with Liver Transplantation performed in FCI-IC between 2009 and 2014

Autor: Olarte Parra, Camila, Pedraza Carvajal, Alejandra, Mejia Hernandez, Gilberto Andres, Benavides Viveros, Carlos, Rivera Baquero, Jairo Eduardo
Přispěvatelé: Rodriguez Padilla, Libia Maria
Jazyk: Spanish; Castilian
Rok vydání: 2016
Předmět:
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Repositorio EdocUR-U. Rosario
Universidad del Rosario
instacron:Universidad del Rosario
DOI: 10.1111/ajt.13182
Popis: Introducción: El tacrolimus es el medicamento de elección para evitar el rechazo al injerto hepático. Su dosis se ajusta a partir de los niveles séricos que se toman periódicamente para asegurar rango terapéutico. Además, niveles elevados se asocian con disfunción renal postrasplante. Sin embargo, no hay consenso frente a los niveles adecuados para pacientes con trasplante hepático. Objetivo: Determinar la relación entre los niveles de tacrolimus y la presencia de rechazo agudo al injerto hepático en pacientes con trasplante hepático realizado en la Fundación Cardioinfantil – Instituto de Cardiología (FCI-IC). Determinar la relación entre los niveles de tacrolimus y la TFG en pacientes con trasplante hepático realizado en la FCI-IC. Métodos: Estudio observacional tipo cohorte histórica en pacientes adultos con trasplante hepático realizado en la FCI-IC entre 2009-2014. Resultados: No se encontró una asociación estadísticamente significativa entre los niveles de tacrolimus y la presencia de rechazo agudo, en sus diferentes definiciones (OR=1,02, p=0,14 y OR=1,01, p=0,29) incluso al ajustar por otras covariables (OR=1,03, p=0,10 y OR=1,02, p=0,25). No fue posible corroborar el diagnóstico con biopsia porque no todos la tenían. Si bien la relación entre los niveles de tacrolimus y la TFG fue estadísticamente significativa (p≤0,001), tiene bajo impacto clínico, pues la TFG disminuyó menos de un punto por cada incremento en 1 ng/ml en los niveles de tacrolimus. Conclusiones: Se necesitan más estudios para establecer la relación entre la exposición a tacrolimus y estos desenlaces para definir si es seguro disminuir su dosis con el fin de reducir los eventos adversos. Introduction: Tacrolimus is the drug of choice to avoid liver graft rejection. Its dose is adjusted based on the trough level concentration that is measured periodically to ensure therapeutic range. Moreover, elevated trough levels are associated with kidney disease after transplantation. However, there is no consensus of the appropriate levels in patients with liver transplantation. Objective: To determine the relationship between the tacrolimus trough levels and the presence of acute graft rejection in patients with liver transplantation in Fundación Cardioinfantil – Instituto de Cardiología (FCI-IC). To determine the relationship between these levels and the glomerular filtration rate (GFR) in patients with liver transplantation in FCI-IC. Methods: Observational, retrospective, cohort study in adult patients with liver transplantation performed in the FCI-IC between 2009 and 2014. Results: There was no statistical significant relationship between the tacrolimus trough levels and the different diagnosis of clinical acute rejection (OR=1. 02, p=0. 14 y OR=1. 01, p=0. 29) even after considering other covariates (OR=1. 03, p=0. 10 y OR=1. 02, p=0. 25). It was no possible to confirm these findings with biopsy as it was not available for all patients. Although the relationship between tacrolimus through levels and GRF was statistically significant (p≤0, 001), the clinical impact is low, as GFR decreased less that one point for every increase in 1 ng/ml of the levels. Conclusion: Further studies are warranted in order to establish the association between the tacrolimus trough levels and these outcomes in order to determine whether it is save to lower the dose of the drug to reduce its adverse events.
Databáze: OpenAIRE