2010 - TTS International Congress


This page contains exclusive content for the member of the following sections: TTS. Log in to view.

Clinical Immunosuppression Kidney early

22.37 - Usefulness of Frequent Tacrolimus Level Estimations as Judged by Outcomes in Renal Transplantation

Presenter: K.S., Ramalingam, Coimbatore, India
Authors: Ramalingam K., Gurumoorthi P., Jansi R., Subha S., Rajesh Kumar J., Vasantha R.

USEFULNESS OF FREQUENT TACROLIMUS LEVEL ESTIMATIONS AS JUDGED BY OUTCOMES IN RENAL TRANSPLANTATION

CLINICAL IMMUNOSUPPRESSION - KIDNEY EARLY

K.S. Ramalingam, P. Gurumoorthi, R. Jansi, S. Subha, J. Rajesh kumar, R. Vasantha
Nephrology, Coimbatore Kidney Centre, Coimbatore/INDIA

Body:
Introduction: Tacrolimus is one of the immunosuppressive drugs used in our centre for the last 5 years. 546 patients are on tacrolimus. Tacrolimus doses are adjusted according to trough levels donefrequently. Our objective is to study the usefulness of frequent level estimations in achieving good outcomes in relation to toxicity and acute rejection and to decide acceptable target levels atdifferent time points. We also aim to study the effect of reduced dose after 6 months on long term graft function. Methods: Tacrolimus trough levels were estimated using IMEX MEIA assay. Creatininewas estimated using Jaffe method by Hitachi 902 auto analyzer. 10626 level estimations in 546 transplant patients were correlated with corresponding doses and creatinine values during followup. Acuteevents such as rejection and toxicity diagnosed by histopathological evidence were associated with tacrolimus levels. Results: A total of 10626 levels were done (30+/-17.4 estimations at first 3months and 9.0+/-8 at 4-12 months) during followup. The trough levels were 8.9+/-4.4(1-30days), 9.0+/-3.1(31-90),8.1+/-2.7(91-180),7.4+/-2.4(181-360)and 6.5+/-2.3 after one year post transplantation.The median creatinine was between 1.0 and 1.1 during this period. The proportion of instances where creatinine was >=1.4mg/dl increased over time (7.5% in the first 30 days to 12.7 after oneyear). Tacrolimus toxicity was seen in 34(6.2%), and acute rejection was observed in 60 (11.0%) patients . Toxicity was associated with raised levels. Patients having one or more instances of levels>12ng/ml in the first 90 days were 2.6 times more likely to have toxicity. Rejection was not statistically significantly associated with tacrolimus levels, but levels were low in most of therejection episodes. Doses adjusted according to levels came down with time. The same dose achieved higher levels with time. The average dose required after 3 months in more than 50% of the patientswas less than or equal to 4.0 mg/day. Dose change was associated with expected change in levels. The variation in levels and dose between and within patients was more during the first 3 months. Theresponse to dose change was also unpredictable in the first 3 months. 70.2% of times a level estimation was useful to change the dose. Reducing the dose less than or equal to 2mg/day from 6 monthsdid not lead to graft loss or rejection in the next three years. Conclusions: Trough level estimation is useful. Frequency of level estimations can be reduced, but in the initial days, the presentfrequency has to be continued. Toxicity can be predicted by high levels. Low levels may predispose to acute rejection. Low dose is not associated with increased graft loss or rejection rates.Considering low rejection and toxicity rates, average levels we achieved seem to be acceptable target levels.

Disclosure: All authors have declared no conflicts of interest.


Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada