Breslin Nadine T, Hedvat Jessica, Salerno David M, Jandovitz Nicholas, Patel Chandni, Lee Sara, Lange Nicholas W
Department of Pharmacy, North Shore University Hospital, Manhasset, New York, USA.
Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA.
Clin Transplant. 2022 Feb;36(2):e14529. doi: 10.1111/ctr.14529. Epub 2021 Nov 24.
The recommended initial weight-based dose of extended-release (XR) tacrolimus (Envarsus XR) in kidney transplant recipients (KTR) is 0.14 mg/kg/day. However, no data exist regarding dosing recommendations for obese patients specifically. The aim of this study was to evaluate weight-based dosing requirements in a cohort of obese KTR who were initiated on de novo tacrolimus XR post-transplantation. The primary outcome was weight-based dosing requirements (mg/kg/day) on post-operative day (POD) 7 and 14. Of the 254 KTR, 81 (31%) were obese. The median therapeutic dose on POD7 was 0.1 versus 0.12 vs. 0.14 mg/kg/day in the BMI > 30 kg/m , BMI 25-30 kg/m , and BMI < 25 kg/m , respectively, (p = .0001). This result was similar on POD14; median therapeutic dose was 0.09 versus 0.11 versus 0.15 mg/kg/day in the BMI > 30 kg/m , BMI 25-30 kg/m , and BMI < 25 kg/m , respectively, (p < .001). Therapeutic dose on POD7 and POD14 based on ideal body was similar in all cohorts (p = .238, p = .923, respectively). This finding was supported by a strong linear relationship between ideal body weight (IBW) and therapeutic dose (r = .929). In both obese and non-obese KTR, IBW had a stronger correlation with the therapeutic dose for tacrolimus XR.
肾移植受者（KTR）中，缓释型（XR）他克莫司（安维萨XR）的推荐初始基于体重剂量为0.14毫克/千克/天。然而，目前尚无专门针对肥胖患者给药建议的数据。本研究的目的是评估一组肥胖KTR在移植后开始使用他克莫司XR时基于体重的给药需求。主要结局是术后第7天和第14天基于体重的给药需求（毫克/千克/天）。在254名KTR中，81名（31%）为肥胖患者。术后第7天，体重指数（BMI）>30千克/平方米、BMI为25-30千克/平方米和BMI<25千克/平方米的患者，中位治疗剂量分别为0.1、0.12和0.14毫克/千克/天（p = 0.0001）。术后第14天结果相似；BMI>30千克/平方米、BMI为25-30千克/平方米和BMI<25千克/平方米的患者，中位治疗剂量分别为0.09、0.11和0.15毫克/千克/天（p<0.001）。所有队列中，基于理想体重的术后第7天和第14天治疗剂量相似（分别为p = 0.238和p = 0.923）。理想体重（IBW）与治疗剂量之间存在强线性关系（r = 0.929），支持了这一发现。在肥胖和非肥胖KTR中，IBW与他克莫司XR治疗剂量的相关性更强。
