Intrapatient Variability in Tacrolimus Trough Levels Over 2 Years Affects Long-Term Allograft Outcomes of Kidney Transplantation
This study aimed to determine the impact of tacrolimus (TAC) trough level (C0) intrapatient variability (IPV) over a period of 2 years after kidney transplantation (KT) on allograft outcomes. In total, 1,143 patients with low immunologic risk were enrolled. The time-weighted coefficient variability...
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2021-09-01
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doaj-a3851264c9b8464db6cb62b341d408f62021-09-30T07:17:22ZengFrontiers Media S.A.Frontiers in Immunology1664-32242021-09-011210.3389/fimmu.2021.746013746013Intrapatient Variability in Tacrolimus Trough Levels Over 2 Years Affects Long-Term Allograft Outcomes of Kidney TransplantationYohan Park0Yohan Park1Hanbi Lee2Hanbi Lee3Sang Hun Eum4Sang Hun Eum5Hyung Duk Kim6Hyung Duk Kim7Eun Jeong Ko8Eun Jeong Ko9Chul Woo Yang10Chul Woo Yang11Byung Ha Chung12Byung Ha Chung13Division of Nephrology, Department of Internal Medicine, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, South KoreaTransplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaTransplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaTransplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaTransplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaTransplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaTransplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaTransplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaDivision of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South KoreaThis study aimed to determine the impact of tacrolimus (TAC) trough level (C0) intrapatient variability (IPV) over a period of 2 years after kidney transplantation (KT) on allograft outcomes. In total, 1,143 patients with low immunologic risk were enrolled. The time-weighted coefficient variability (TWCV) of TAC-C0 was calculated, and patients were divided into tertile groups (T1: < 24.6%, T2: 24.6%–33.7%, T3: ≥ 33.7%) according to TAC-C0-TWCV up to post-transplant 1st year. They were classified into the low/low, low/high, high/low, and high/high groups based on a TAC-C0-TWCV value of 33.7% during post-transplant 0–1st and 1st–2nd years. The allograft outcomes among the three tertile and four TAC-C0-TWCV groups were compared. The T3 group had the highest rate of death-censored allograft loss (DCGL), and T3 was considered an independent risk factor for DCGL. The low/low group had the lowest and the high/high group had the highest risk for DCGL. Moreover, patients with a mean TAC-C0 of ≥5 ng/ml in the high/high group were at the highest risk for DCGL. Thus, TAC-IPV can significantly affect allograft outcomes even with a high mean TAC-C0. Furthermore, to improve allograft outcomes, a low TAC-IPV should be maintained even after the first year of KT.https://www.frontiersin.org/articles/10.3389/fimmu.2021.746013/fullallograftrejectiontransplantgraft survivaltacrolimus |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yohan Park Yohan Park Hanbi Lee Hanbi Lee Sang Hun Eum Sang Hun Eum Hyung Duk Kim Hyung Duk Kim Eun Jeong Ko Eun Jeong Ko Chul Woo Yang Chul Woo Yang Byung Ha Chung Byung Ha Chung |
spellingShingle |
Yohan Park Yohan Park Hanbi Lee Hanbi Lee Sang Hun Eum Sang Hun Eum Hyung Duk Kim Hyung Duk Kim Eun Jeong Ko Eun Jeong Ko Chul Woo Yang Chul Woo Yang Byung Ha Chung Byung Ha Chung Intrapatient Variability in Tacrolimus Trough Levels Over 2 Years Affects Long-Term Allograft Outcomes of Kidney Transplantation Frontiers in Immunology allograft rejection transplant graft survival tacrolimus |
author_facet |
Yohan Park Yohan Park Hanbi Lee Hanbi Lee Sang Hun Eum Sang Hun Eum Hyung Duk Kim Hyung Duk Kim Eun Jeong Ko Eun Jeong Ko Chul Woo Yang Chul Woo Yang Byung Ha Chung Byung Ha Chung |
author_sort |
Yohan Park |
title |
Intrapatient Variability in Tacrolimus Trough Levels Over 2 Years Affects Long-Term Allograft Outcomes of Kidney Transplantation |
title_short |
Intrapatient Variability in Tacrolimus Trough Levels Over 2 Years Affects Long-Term Allograft Outcomes of Kidney Transplantation |
title_full |
Intrapatient Variability in Tacrolimus Trough Levels Over 2 Years Affects Long-Term Allograft Outcomes of Kidney Transplantation |
title_fullStr |
Intrapatient Variability in Tacrolimus Trough Levels Over 2 Years Affects Long-Term Allograft Outcomes of Kidney Transplantation |
title_full_unstemmed |
Intrapatient Variability in Tacrolimus Trough Levels Over 2 Years Affects Long-Term Allograft Outcomes of Kidney Transplantation |
title_sort |
intrapatient variability in tacrolimus trough levels over 2 years affects long-term allograft outcomes of kidney transplantation |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Immunology |
issn |
1664-3224 |
publishDate |
2021-09-01 |
description |
This study aimed to determine the impact of tacrolimus (TAC) trough level (C0) intrapatient variability (IPV) over a period of 2 years after kidney transplantation (KT) on allograft outcomes. In total, 1,143 patients with low immunologic risk were enrolled. The time-weighted coefficient variability (TWCV) of TAC-C0 was calculated, and patients were divided into tertile groups (T1: < 24.6%, T2: 24.6%–33.7%, T3: ≥ 33.7%) according to TAC-C0-TWCV up to post-transplant 1st year. They were classified into the low/low, low/high, high/low, and high/high groups based on a TAC-C0-TWCV value of 33.7% during post-transplant 0–1st and 1st–2nd years. The allograft outcomes among the three tertile and four TAC-C0-TWCV groups were compared. The T3 group had the highest rate of death-censored allograft loss (DCGL), and T3 was considered an independent risk factor for DCGL. The low/low group had the lowest and the high/high group had the highest risk for DCGL. Moreover, patients with a mean TAC-C0 of ≥5 ng/ml in the high/high group were at the highest risk for DCGL. Thus, TAC-IPV can significantly affect allograft outcomes even with a high mean TAC-C0. Furthermore, to improve allograft outcomes, a low TAC-IPV should be maintained even after the first year of KT. |
topic |
allograft rejection transplant graft survival tacrolimus |
url |
https://www.frontiersin.org/articles/10.3389/fimmu.2021.746013/full |
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