Impact of Tacrolimus Trough Variability on Acute Rejection Following Lung Transplantation |
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| Institution: | 1. Department of Pharmacy, Duke Health, Durham, North Carolina, United States;2. Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States;3. Division of Pulmonary, Allergy and Critical Care, Duke Health, Durham, North Carolina, United States;1. Cantonal Hospital Orasje, Orasje, Bosnia and Herzegovina;2. Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina;3. General Hospital “Prim. Dr Abdulah Nakas”, Sarajevo, Bosnia and Herzegovina;1. Department of Medical Technology, Division of Rehabilitation Technology, Kumamoto University Hospital, Kumamoto, Japan;2. Department of Physical Medicine and Rehabilitation, Kumamoto University Hospital, Kumamoto, Japan;3. Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan;1. Nephrology Department, Hospital del Mar, Institute Mar for Medical Research, Barcelona, Spain;2. Nephrology Department, Hospital 12 de Octubre, Madrid, Spain;3. Nephrology Department, Hospital La Paz, Madrid, Spain;4. Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland;5. Nephrology Department, Hospital Vall d''Hebron, Barcelona, Spain;6. Transplant Infectious Diseases Division, Massachusetts General Hospital, Boston, MA, United States of America;7. Nephrology Department, Hospital Puerta de Hierro, Madrid, Spain;8. Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany;9. Department of Nephrology, Rigshospitalet University Hospital Copenhagen, Denmark;10. Immunology Department, Hospital 12 de Octubre, Madrid, Spain;11. Biohope Scientific Solutions for Human Health, Madrid, Spain;1. Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand;2. Department of Surgery, Pokhara Academy of Health Sciences, Nepal;1. Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut;2. Department of Surgery, Waterbury Hospital, Waterbury, Connecticut;3. Hartford Healthcare Research Department, Hartford, Connecticut;4. Hartford Hospital Transplant & Comprehensive Liver Center, Hartford, Connecticut |
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| Abstract: | BackgroundAcute rejection is a risk factor for the development of chronic lung allograft dysfunction, the leading cause of morbidity and mortality in lung transplant recipients. Calcineurin inhibitors are the cornerstone of immunosuppression regimens after lung transplantation.MethodsWe retrospectively evaluated the association of tacrolimus level variability with total acute rejection score at 12 months post-transplant. Secondary outcomes included the development of chronic lung allograft dysfunction and antibody-mediated rejection at 24months post-transplant. There were 229 lung transplant recipients included.ResultsThe mean (standard deviation) total rejection score of the cohort was 1.6 (1.7). Patients with high tacrolimus variability at 0 to 3, 3 to 6, and 6 to 12 months on average scored 0.18 (mean 1.6 vs 1.5; 95% CI): -0.3 to 0.66, P =.46), 0.14 (mean 1.7 vs 1.5; 95% CI: -0.32 to 0.6, P = .55), and 0.12 (mean 1.6 vs 1.5; 95% CI: -0.34 to 0.58, P = .62) point higher in 12-month total acute rejection scores, respectively; however, these differences were not statistically significant. The incidences of chronic lung allograft dysfunction and antibody-mediated rejection were numerically greater in the high variability group throughout certain periods; however, this was not consistent throughout all study timeframes and statistical significance was not evaluated.ConclusionsHigh tacrolimus variability was not associated with increased 12-month total acute rejection score. Further studies are needed to assess long-term outcomes with tacrolimus level variability. |
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