Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK.
J Ren Care. 2021 Mar;47(1):51-57. doi: 10.1111/jorc.12339. Epub 2020 Jul 30.
Tacrolimus dosing immediately posttransplant is based on body weight. Recent studies have highlighted that the dosing of tacrolimus purely based on weight may not be appropriate, particularly in individuals who are obese.
This study aimed to estimate the effect of body mass index (BMI) and the weight-based dosing on tacrolimus trough levels in recipients of renal transplants.
This study was conducted on 400 of the 863 patients registered in the Salford, UK, renal transplant database between 2012 and 2019 who had complete and analysable datasets. Data were collected at baseline (first tacrolimus trough level after transplantation), after 1 month and 6 months posttransplantation. The cohort was split into three groups based on BMI (kg/m ; Group 1 ≤ 25, Group 2 > 25-30 and Group 3 > 30) which were compared with respect to tacrolimus dose, plasma levels and concentration/dose (C/D) ratio at the three-time points.
Patients in the higher BMI group (Group 3) had significantly higher baseline tacrolimus trough levels despite receiving a lower initiation dose per kilogram of body weight. After 1 and 6-months posttransplant, the higher BMI group were receiving a significantly lower tacrolimus dose relative to their body weight, with a significant negative correlation between body weight and tacrolimus/kg body weight. There was no adverse relationship evident between tacrolimus dosing or concentration and graft function.
Our study showed that standard dosing of tacrolimus based on body weight in individuals who were obese did not adversely affect their tacrolimus concentrations or transplant function.
移植后即刻的他克莫司剂量基于体重。最近的研究强调，单纯基于体重的他克莫司剂量可能并不合适，尤其是在肥胖个体中。
本研究旨在评估体重指数（BMI）和基于体重的剂量对肾移植受者他克莫司谷浓度的影响。
这项研究在 2012 年至 2019 年间，英国索尔福德肾脏移植数据库中登记的 863 名患者中进行，共纳入了 400 名患者，这些患者有完整且可分析的数据。数据采集于移植后第 1 次他克莫司谷浓度（移植后第 1 次）、1 个月和 6 个月时。该队列根据 BMI（kg/m ）分为三组（组 1：≤25kg/m ；组 2：>25-30kg/m ；组 3：>30kg/m ），比较三组在三个时间点的他克莫司剂量、血药浓度和浓度/剂量（C/D）比值。
尽管较高 BMI 组（组 3）的起始剂量按体重计算较低，但基线时他们的他克莫司谷浓度明显较高。移植后 1 个月和 6 个月时，较高 BMI 组的他克莫司剂量相对体重明显较低，体重与他克莫司/体重的相关性呈显著负相关。在他克莫司剂量或浓度与移植物功能之间没有明显的不良关系。
我们的研究表明，在肥胖个体中，基于体重的标准他克莫司剂量不会对其他克莫司浓度或移植功能产生不良影响。
