2013 - ISBTS 2013 Symposium
This page contains exclusive content for the member of the following sections: TTS, IXA, ITA. Log in to view.
Mini-Oral Communications 2
26.353 - Comparison between oral (liquid and Modigraf®) and intravenous Tacrolimus in intestinal transplant patients
Presenter: Tracey, Oseland, , United Kingdom
Authors: Tracey Oseland1, Saravanan Jayachandran1, Khalid Sharif1, Paolo Muiesan1, Darius Mirza1, Girish Gupte1
Comparison between oral (liquid and Modigraf®) and intravenous Tacrolimus in intestinal transplant patients
Tracey Oseland1, Saravanan Jayachandran1, Khalid Sharif1, Paolo Muiesan1, Darius Mirza1, Girish Gupte1
1Liver Unit (including small bowel transplantation), Birmingham Children's Hospital, Birmingham, United Kingdom
Background: Achieving optimal Tacrolimus levels (TL), either by oral liquid (O-T), IV route (IV-T) or Modigraf® (M-T) early in post intestinal transplantation (ITx) is ideal to prevent acute rejection.
Aim: To report on single centre experience of different forms of Tacrolimus formulation in intestinal transplantation patients.
Subject and Methods: Records of three groups were retrieved for a prospectively maintained database. Group 1 was started on O-T dose of 0.075mg/kg/dose; this was changed to IV-T 24 hour infusion of 0.15mg/kg/day if low levels persisted. Group 2 was started on IV-T 24 hour infusion of 0.05mg/kg/day. Group 3 was started on Modigraf® (Tacrolimus granules) at 0.3mg/kg/day. Target TL (measured once daily) for all the groups were aimed at 15-20ng/ml in the first 21 days, then 12-15ng/ml until the third month.
Results:
|
Median (range)
|
Group 1 (n=10)
|
Group 2 (n=11)
|
Group 3 (n=14)
|
|
Age in months
|
24 (12-54)
|
40 (15.7-169.4)
|
40.62 (16-112)
|
|
Gender (M:F)
|
4:6
|
8:3
|
7:7
|
|
Days on IV-T in 1st 30 days
|
18 (1-26)
|
16.3 (4-30)
|
0
|
|
TL of each patient 1st 30 days in ng/l
|
18.1
|
8.5
|
15.5
|
|
Rejection episodes while on IV-T
|
3 (mild to moderate)
|
2 (severe)
|
n/a
|
|
Rejection episodes in the first 30 days
|
70% (7/10)
|
73% (8/11)
|
29% (4/14)
|
|
Post Transplant lymphoproliferative disease (PTLD) episodes
(1st 6months)
|
0
|
5
|
2
|
TL was in target range in 24%, 28% and 28% of days in Groups 1, 2 and 3 respectively. Most of group 2 (IV-T) patients were higher than target range (47% of days) while most of group 1 (O-T) and group 3 (M-T) patients TL were lower than target range (42% and 38% of days respectively), despite frequent dose modification. 9/10 patients in group 1 were switched to IV-T on the 5th day (3/29). Group 2 patients were converted from IV-T to O-T within 5 days (0-14) while IV-T was not needed in group 3 patients. Higher incidence of PTLD and opportunistic infections were noted in children receiving IV-T at induction. Lesser incidence on episodes and severity of rejection was evident in the group 3 patients.
Conclusion: Modigraf® granules provide steady levels in ITx patients and less complication that IV-T. Modigraf granules are safe to use intestinal transplants.
Important Disclaimer
By viewing the material on this site you understand and accept that:
- 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.
- The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
- The material is solely for educational purposes for qualified health care professionals.
- 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.
- The information cannot be used as a substitute for professional care.
- The information does not represent a standard of care.
- No physician-patient relationship is being established.
Contact
Address
The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada