Conversion from Standard-Release Tacrolimus to MeltDose^® Tacrolimus (LCPT) Improves Renal Function after Liver Transplantation

• Main Authors: Johannes von Einsiedel, Gerold Thölking, Christian Wilms, Elena Vorona, Arne Bokemeyer, Hartmut H. Schmidt, Iyad Kabar, Anna Hüsing-Kabar
• Format: Article
• Language: English
• Published: MDPI AG 2020-06-01
• Series: Journal of Clinical Medicine
• Subjects: MeltDose^®; LCPT; tacrolimus; renal function; liver transplantation; C/D ratio
• Online Access: https://www.mdpi.com/2077-0383/9/6/1654

Renal impairment is a typical side effect of tacrolimus (Tac) treatment in liver transplant (LT) recipients. One strategy to avoid renal dysfunction is to increase the concentration/dose (C/D) ratio by improving drug bioavailability. LT recipients converted from standard-release Tac to MeltDose^® Tac (LCPT), a novel technological formulation, were able to reduce the required Tac dose due to higher bioavailability. Hence, we hypothesize that such a conversion increases the C/D ratio, resulting in a preservation of renal function. In the intervention group, patients were switched from standard-release Tac to LCPT. Clinical data were collected for 12 months after conversion. Patients maintained on standard-release Tac were enrolled as a control group. Twelve months after conversion to LCPT, median C/D ratio had increased significantly by 50% (<i>p</i> < 0.001), with the first significant increase seen 3 months after conversion (<i>p</i> = 0.008). In contrast, C/D ratio in the control group was unchanged after 12 months (1.75 vs. 1.76; <i>p</i> = 0.847). Estimated glomerular filtration rate (eGFR) had already significantly deteriorated in the control group at 9 months (65.6 vs. 70.6 mL/min/1.73 m² at study onset; <i>p</i> = 0.006). Notably, patients converted to LCPT already had significant recovery of mean eGFR 6 months after conversion (67.5 vs. 65.3 mL/min/1.73 m² at study onset; <i>p</i> = 0.029). In summary, conversion of LT recipients to LCPT increased C/D ratio associated with renal function improvement.