Department of Nephrology, Austin Health, Heidelberg, VIC, Australia.
Department of Medicine, University of Melbourne, Parkville, VIC, Australia.
Clin Transplant. 2022 Jun;36(6):e14606. doi: 10.1111/ctr.14606. Epub 2022 Feb 23.
Achieving therapeutic tacrolimus levels is an essential component of balancing immunosuppression in kidney transplantation. At our institution, the starting tacrolimus dose was reduced from .075 mg/kg BD (higher dose [HD]) to .050 mg/kg BD (lower dose [LD]), to better achieve our target level of 6-10 μg/L in the early posttransplant period. Kidney transplant recipients (KTRs) transplanted 1-year before (HD: n = 64) and after (LD: n = 63) the starting dose reduction were retrospectively compared. Achieved tacrolimus levels were significantly lower in the LD group during the first 14 days posttransplant, but not at day 21 or day 28. A higher proportion of LD KTRs achieved therapeutic levels (day 1-3: 36.1% vs. 18.8%; day 4-7: 50.8% vs. 40.6%, day 8-14: 83.6% vs. 71.7%), while the HD KTRs were more likely to have supratherapeutic levels. Tacrolimus dose was significantly lower on day 5 compared to day 0 in the HD group but similar in the LD group. Rates of delayed graft function, posttransplant diabetes, and treated rejection at 6 months and graft outcomes at 3 years were all similar. Lowering the starting tacrolimus dose increased the proportion of KTRs achieving therapeutic range and minimized dose changes early posttransplant without an impact on clinical outcomes.
实现治疗性他克莫司水平是平衡肾移植中免疫抑制的重要组成部分。在我们的机构中，他克莫司的起始剂量从 0.075mg/kg BID（高剂量 [HD]）降低至 0.050mg/kg BID（低剂量 [LD]），以更好地在移植后早期达到我们 6-10μg/L 的目标水平。回顾性比较了起始剂量降低前 1 年（HD：n=64）和后 1 年（LD：n=63）接受肾移植的患者。在移植后的前 14 天，LD 组的他克莫司水平明显较低，但在第 21 天或第 28 天没有差异。LD KTR 达到治疗水平的比例更高（第 1-3 天：36.1% vs. 18.8%；第 4-7 天：50.8% vs. 40.6%，第 8-14 天：83.6% vs. 71.7%），而 HD KTR 更有可能出现超治疗水平。与 HD 组相比，LD 组第 5 天的他克莫司剂量明显低于第 0 天，但在 LD 组中相似。移植后 6 个月时延迟移植物功能、移植后糖尿病和治疗性排斥反应的发生率以及 3 年的移植物结局均相似。降低起始他克莫司剂量可增加达到治疗范围的 KTR 比例，并最大限度地减少移植后早期的剂量变化，而对临床结局没有影响。
