Significant reduction of Tacrolimus trough level after conversion from twice daily Prograf to once daily Advagraf in Chinese renal transplant recipients with or without concomitant diltiazem treatment

Abstract

A dose ratio of 1:1 was recommended for the conversion from Standard-release Tacrolimus (Prograf) to Prolonged-release Tacrolimus (Advagraf). We investigated the trough tacrolimus blood level in Chinese kidney transplant recipients after conversion, including subjects receiving concomitant treatment with diltiazem. Eighteen stable renal allograft recipients were followed prospectively for 12 weeks after conversion from Prograf to Advagraf at the same daily dose. Tacrolimus blood trough level decreased significantly within 8 weeks after conversion (p?0.01). Twelve patients required escalation of the Advagraf dose by 1.10?±?0.36?mg. For the whole group the daily tacrolimus dose was increased from 0.057?±?0.032?mg/kg to 0.068?±?0.033?mg/kg (p?0.0001). At week 12 the daily dose of Advagraf was 127?±?32% of the original daily dose of Prograf. In the subgroup of patients receiving diltiazem, their tacrolimus trough level decreased significantly after conversion (p?=?0.001), and the daily tacrolimus dose was increased from 0.060?±?0.036?mg/kg to 0.073?±?0.036?mg/kg (p?0.0001). At week 12, their daily dose of Advagraf was 131?±?34% of the original daily dose before conversion. To conclude, conversion from Prograf to Advagraf in renal allograft recipients with or without diltiazem co-treatment necessitated an increase in the daily dose by approximately 30% to maintain the target blood trough level unchanged.