Hsiao Chih-Yang, Ho Ming-Chih, Ho Cheng-Maw, Wu Yao-Ming, Lee Po-Huang, Hu Rey-Heng
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City 110, Taiwan.
Department of Surgery, National Taiwan University College of Medicine, Taipei City 110, Taiwan.
J Pers Med. 2021 Feb 1;11(2):90. doi: 10.3390/jpm11020090.
Tacrolimus is the most widely used immunosuppressant in liver transplant (LT) patients. However, the ideal long-term target level for these patients is unknown. This retrospective study aimed to investigate the impact of tacrolimus blood concentration five years after LT on long-term patient survival outcomes in adult LT recipients. Patients who underwent LT between January 2004 and July 2014 at a tertiary medical center were included in this study ( = 189). The mean tacrolimus blood concentrations of each patient during the fifth year after LT were recorded and the overall survival rate was determined. A multivariate analysis of factors associated with long-term survival was conducted using a Cox's model. The median follow-up period was 9.63 years, and 144 patients (76.2%) underwent live donor LT. Sixteen patients died within 5 years of LT. In the Cox's model, patients with a mean tacrolimus blood trough level of 4.6-10.2 ng/mL had significantly better long-term survival than those with a mean tacrolimus blood trough level outside this range (estimated hazard ratio = 4.76; 95% confidence interval: 1.34-16.9, = 0.016). Therefore, a tacrolimus level no lower than 4.6 ng/mL would be recommended in adult LT patients.
他克莫司是肝移植（LT）患者中使用最广泛的免疫抑制剂。然而，这些患者的理想长期目标水平尚不清楚。这项回顾性研究旨在调查肝移植五年后他克莫司血药浓度对成年肝移植受者长期生存结局的影响。本研究纳入了2004年1月至2014年7月在一家三级医疗中心接受肝移植的患者（n = 189）。记录了每位患者肝移植后第五年的他克莫司平均血药浓度，并确定了总生存率。使用Cox模型对与长期生存相关的因素进行多变量分析。中位随访期为9.63年，144例患者（76.2%）接受了活体供肝肝移植。16例患者在肝移植后5年内死亡。在Cox模型中，他克莫司血药谷浓度平均为4.6 - 10.2 ng/mL的患者长期生存率明显高于血药谷浓度平均不在此范围内的患者（估计风险比 = 4.76；95%置信区间：1.34 - 16.9，P = 0.016）。因此，建议成年肝移植患者的他克莫司水平不低于4.6 ng/mL。
