Department of Surgery, Division of Transplant Surgery, MUSC, Charleston, South Carolina, USA.
Department of Pharmacy Services, MUSC, Charleston, South Carolina, USA.
Clin Transplant. 2023 May;37(5):e14941. doi: 10.1111/ctr.14941. Epub 2023 Feb 27.
The influence of converting to once daily, extended-release LCP-Tacrolimus (Tac) for those with high tacrolimus variability in kidney transplant recipients (KTRs) is not well-studied.
Single-center, retrospective cohort study of adult KTRs converted from Tac immediate release to LCP-Tac 1-2 years post-transplant. Primary measures were Tac variability, using the coefficient of variation (CV) and time in therapeutic range (TTR), as well as clinical outcomes (rejection, infections, graft loss, death).
A total of 193 KTRs included with a follow-up of 3.2 ± .7 years and 1.3 ± .3 years since LCP-Tac conversion. Mean age was 52 ± 13 years; 70% were African American, 39% were female, 16% living donor and 12% donor after cardiac death (DCD). In the overall cohort, tac CV was 29.5% before conversion, which increased to 33.4% after LCP-Tac (p = .008). In those with Tac CV >30% (n = 86), conversion to LCP-Tac reduced variability (40.6% vs. 35.5%; p = .019) and for those with Tac CV >30% and nonadherence or med errors (n = 16), LCP-Tac conversion substantially reduced Tac CV (43.4% vs. 29.9%; p = .026). TTR significantly improved for those with Tac CV >30% with (52.4% vs. 82.8%; p = .027) or without nonadherence or med errors (64.8% vs. 73.2%; p = .005). CMV, BK, and overall infections were significantly higher prior to LCP-Tac conversion. In the overall cohort, 3% had rejection before conversion and 2% after (p = NS). At end of follow-up, graft and patient survival were 94% and 96%, respectively.
In those with high Tac CV, conversion to LCP-Tac is associated with a significant reduction in variability and improvement in TTR, particularly in those with nonadherence or medication errors.
对于肾移植受者（KTR）中那些具有高他克莫司变异性的患者，将其转换为每日一次、延长释放的 LCP-他克莫司（Tac）的影响尚未得到充分研究。
这是一项单中心、回顾性队列研究，纳入了在移植后 1-2 年内从 Tac 速释剂转换为 LCP-Tac 的成年 KTR。主要测量指标为 Tac 变异性，使用变异系数（CV）和治疗窗内时间（TTR），以及临床结局（排斥反应、感染、移植物丢失、死亡）。
共纳入 193 名 KTR，随访时间为 3.2±0.7 年，LCP-Tac 转换后随访时间为 1.3±0.3 年。平均年龄为 52±13 岁；70%为非裔美国人，39%为女性，16%为活体供者，12%为心脏死亡后供者（DCD）。在整个队列中，转换前 Tac 的 CV 为 29.5%，转换为 LCP-Tac 后增加至 33.4%（p=0.008）。在 Tac CV>30%的患者中（n=86），转换为 LCP-Tac 可降低变异性（40.6% vs. 35.5%；p=0.019），而在 Tac CV>30%且存在用药不依从或用药错误的患者中（n=16），LCP-Tac 转换可显著降低 Tac CV（43.4% vs. 29.9%；p=0.026）。TTR 显著改善，在 Tac CV>30%且存在（52.4% vs. 82.8%；p=0.027）或不存在用药不依从或用药错误的患者中（64.8% vs. 73.2%；p=0.005）。CMV、BK 和总体感染在转换为 LCP-Tac 之前显著更高。在整个队列中，转换前有 3%的患者发生排斥反应，转换后有 2%的患者发生（p=NS）。在随访结束时，移植物和患者的存活率分别为 94%和 96%。
在 Tac CV 较高的患者中，转换为 LCP-Tac 可显著降低变异性并改善 TTR，特别是在那些存在用药不依从或用药错误的患者中。
