Successful conversion from twice-daily to once-daily tacrolimus in liver transplantation: observational multicenter study

Dopazo C, Rodriguez R, Llado L, Calatayud D, Castells L, Ramos E, Molina V, García R, Fabregat J, Charco R. Successful conversion from twice‐daily to once‐daily tacrolimus in liver transplantation: observational multicenter study.
Clin Transplant 2012: 26: E32–E37.
© 2011 John Wiley & Sons A/S. Background: Compliance with immunosuppressive therapy in liver transplant patients is critical to prevent acute organ rejection and/or late graft loss. Strategies to simplify the therapeutic regimen may improve adherence. Aim: To evaluate the safety and efficacy of conversion from a twice‐daily to once‐daily tacrolimus formulation in adult liver transplant patients. Patients and methods: This prospective observational multicenter study included 187 liver transplant patients with at least 10 months post‐transplant follow‐up, no rejection episodes in the last three months, and creatinine levels <2 mg/dL. Conversion from a twice‐daily to a once‐daily formulation was based on a 1:1 proportion. Results: Median age was 61 yr (range: 28–80 yr); 64% were men and 36% women. The main indications for liver transplant were alcoholic cirrhosis in 30%. Median conversion time was 55 months (range: 10–215 months). Serum tacrolimus levels decreased at one month after conversion (pre‐conversion levels = 5.4 ± 3.0 ng/mL vs. post‐conversion levels = 4.4 ± 2.4 ng/mL, p = 0.013); however, these values normalized at six months post‐conversion with no changes in liver function and rejection episodes were observed only in two patients. Conclusion: Conversion from a twice‐daily to a once‐daily tacrolimus formulation is a safe, effective strategy in the management of stable liver transplant patients.