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Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients.
PLoS One. 2020; 15(7):e0235418.Plos

Abstract

BACKGROUND

Little is known regarding optimal tacrolimus (TAC) trough levels after 1 year post-transplant in stable kidney transplant recipients (KTRs) who have not experienced renal or cardiovascular outcomes. This study aimed to investigate the effect of 1-year post-transplant TAC trough levels on long-term renal and cardiovascular outcomes and opportunistic infections in stable KTRs.

METHODS

KTRs receiving TAC with mycophenolate-based immunosuppression who did not experience renal or cardiovascular outcomes within 1 year post-transplant were enrolled from a multicenter observational cohort study. Renal outcome was defined as a composite of biopsy-proven acute rejection, interstitial fibrosis and tubular atrophy, and death-censored graft loss. Cardiovascular outcome was defined as a composite of de novo cardiomegaly, left ventricular hypertrophy, and cardiovascular events. Opportunistic infections were defined as the occurrence of BK virus or cytomegalovirus infections.

RESULTS

A total of 603 eligible KTRs were divided into the low-level TAC (LL-TAC) and high-level TAC (HL-TAC) groups based on a median TAC level of 5.9 ng/mL (range 1.3-14.3) at 1 year post-transplant. The HL-TAC group had significantly higher TAC trough levels at 2, 3, 4, and 5 years compared with the levels of the LL-TAC group. During the mean follow-up of 63.7 ± 13.0 months, there were 121 renal outcomes and 224 cardiovascular outcomes. In multivariate Cox regression analysis, LL-TAC and HL-TAC were not independent risk factors for renal and cardiovascular outcomes, respectively. No significant differences in the development of opportunistic infections and de novo donor-specific anti-human leukocyte antigen antibodies and renal allograft function were observed between the two groups.

CONCLUSIONS

TAC trough levels after 1 year post-transplant remained at a similar level until the fifth year after kidney transplantation and were not directly associated with long-term outcomes in stable Korean KTRs who did not experience renal or cardiovascular outcomes. Therefore, in Asian KTRs with a stable clinical course, TAC trough levels higher than approximately 6 ng/mL might not be required after a year of kidney transplantation.

Authors+Show Affiliations

Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.Department of Internal Medicine, Pohang St. Mary's Hospital, Pohang, South Korea.Department of Statistics, Kyungpook National University, Daegu, South Korea.Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.Department of Surgery, Sungkyunkwan University, Seoul Samsung Medical Center, Seoul, South Korea.Department of Surgery, Korea University College of Medicine, Seoul, South Korea.Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, South Korea.Department of Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, South Korea.Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, South Korea.Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32614859

Citation

Jung, Hee-Yeon, et al. "Tacrolimus Trough Levels Higher Than 6 ng/mL Might Not Be Required After a Year in Stable Kidney Transplant Recipients." PloS One, vol. 15, no. 7, 2020, pp. e0235418.
Jung HY, Seo MY, Jeon Y, et al. Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients. PLoS ONE. 2020;15(7):e0235418.
Jung, H. Y., Seo, M. Y., Jeon, Y., Huh, K. H., Park, J. B., Jung, C. W., Lee, S., Han, S. Y., Ro, H., Yang, J., Ahn, C., Choi, J. Y., Cho, J. H., Park, S. H., Kim, Y. L., & Kim, C. D. (2020). Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients. PloS One, 15(7), e0235418. https://doi.org/10.1371/journal.pone.0235418
Jung HY, et al. Tacrolimus Trough Levels Higher Than 6 ng/mL Might Not Be Required After a Year in Stable Kidney Transplant Recipients. PLoS ONE. 2020;15(7):e0235418. PubMed PMID: 32614859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients. AU - Jung,Hee-Yeon, AU - Seo,Min Young, AU - Jeon,Yena, AU - Huh,Kyu Ha, AU - Park,Jae Berm, AU - Jung,Cheol Woong, AU - Lee,Sik, AU - Han,Seung-Yeup, AU - Ro,Han, AU - Yang,Jaeseok, AU - Ahn,Curie, AU - Choi,Ji-Young, AU - Cho,Jang-Hee, AU - Park,Sun-Hee, AU - Kim,Yong-Lim, AU - Kim,Chan-Duck, Y1 - 2020/07/02/ PY - 2020/05/11/received PY - 2020/06/15/accepted PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/3/medline SP - e0235418 EP - e0235418 JF - PloS one JO - PLoS ONE VL - 15 IS - 7 N2 - BACKGROUND: Little is known regarding optimal tacrolimus (TAC) trough levels after 1 year post-transplant in stable kidney transplant recipients (KTRs) who have not experienced renal or cardiovascular outcomes. This study aimed to investigate the effect of 1-year post-transplant TAC trough levels on long-term renal and cardiovascular outcomes and opportunistic infections in stable KTRs. METHODS: KTRs receiving TAC with mycophenolate-based immunosuppression who did not experience renal or cardiovascular outcomes within 1 year post-transplant were enrolled from a multicenter observational cohort study. Renal outcome was defined as a composite of biopsy-proven acute rejection, interstitial fibrosis and tubular atrophy, and death-censored graft loss. Cardiovascular outcome was defined as a composite of de novo cardiomegaly, left ventricular hypertrophy, and cardiovascular events. Opportunistic infections were defined as the occurrence of BK virus or cytomegalovirus infections. RESULTS: A total of 603 eligible KTRs were divided into the low-level TAC (LL-TAC) and high-level TAC (HL-TAC) groups based on a median TAC level of 5.9 ng/mL (range 1.3-14.3) at 1 year post-transplant. The HL-TAC group had significantly higher TAC trough levels at 2, 3, 4, and 5 years compared with the levels of the LL-TAC group. During the mean follow-up of 63.7 ± 13.0 months, there were 121 renal outcomes and 224 cardiovascular outcomes. In multivariate Cox regression analysis, LL-TAC and HL-TAC were not independent risk factors for renal and cardiovascular outcomes, respectively. No significant differences in the development of opportunistic infections and de novo donor-specific anti-human leukocyte antigen antibodies and renal allograft function were observed between the two groups. CONCLUSIONS: TAC trough levels after 1 year post-transplant remained at a similar level until the fifth year after kidney transplantation and were not directly associated with long-term outcomes in stable Korean KTRs who did not experience renal or cardiovascular outcomes. Therefore, in Asian KTRs with a stable clinical course, TAC trough levels higher than approximately 6 ng/mL might not be required after a year of kidney transplantation. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/32614859/Tacrolimus_trough_levels_higher_than_6_ng/mL_might_not_be_required_after_a_year_in_stable_kidney_transplant_recipients L2 - https://dx.plos.org/10.1371/journal.pone.0235418 DB - PRIME DP - Unbound Medicine ER -
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