Association of graft survival with tacrolimus exposure and late intra-patient tacrolimus variability in pediatric and young adult renal transplant recipients

• Verfasst von: Gold, Annika [VerfasserIn]
• Verfasst von: Tönshoff, Burkhard [VerfasserIn]
• Verfasst von: Döhler, Bernd [VerfasserIn]
• Verfasst von: Süsal, Caner [VerfasserIn]
• Titel: Association of graft survival with tacrolimus exposure and late intra-patient tacrolimus variability in pediatric and young adult renal transplant recipients
• Titelzusatz: an international CTS registry analysis
• Verf.angabe: Annika Gold, Burkhard Tönshoff, Bernd Döhler & Caner Süsal
• Jahr: 2020
• Umfang: 12 S.
• Fussnoten: First published: 02 September 2020 ; Gesehen am 13.12.2021
• Titel Quelle: Enthalten in: Transplant international
• Ort Quelle: Oxford [u.a.] : Wiley-Blackwell, 1988
• Jahr Quelle: 2020
• Band/Heft Quelle: 33(2020), 12, Seite 1681-1692
• ISSN Quelle: 1432-2277
• DOI: doi:10.1111/tri.13726
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: late intra-patient tacrolimus variability
• Sach-SW: pediatrics
• Sach-SW: renal allograft survival
• Sach-SW: tacrolimus exposure
• Sach-SW: young adults
• K10plus-PPN: 1782039678
• K10plus-PPN:
  Universitätsbibliothek
• Lokale URL UB: Zum Volltext

Abstract

Adolescent and young adult age is a high-risk window with an alarmingly increased likelihood of premature kidney graft loss due to immunological rejection. Using the large database of the Collaborative Transplant Study, we analyzed whether a more intense and less variable exposure to tacrolimus could counteract this young age-related enhanced immunoreactivity. Kidney graft recipients aged 12-23 years (n = 964) with a 1-year tacrolimus trough level between 4.0 and 10.9 ng/ml had a 5-year graft survival rate of 85.1%, significantly better than the poor 66.1% rate in patients with a trough level below 4.0 ng/ml who showed a 2.38-fold increased risk of graft loss in the multivariable analysis (P < 0.001). This association was not apparent in young children aged 0-11 years (n = 455) and less pronounced in adults aged 24-34 years (n = 1466). However, an intra-patient variability of tacrolimus (IPV) trough level ≥1.5 at post-transplant years 1 and 2 was associated with an increased graft loss risk in both 12- to 23-year-old and 0- to 11-year-old recipients (P < 0.001 and P = 0.045). Patients with high IPV made up as many as 30% of kidney graft recipients, indicating that a more intense and less variable exposure to tacrolimus could improve graft survival strongly in this high-risk group.