Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil.
Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil ; and.
Ther Drug Monit. 2024 Aug 1;46(4):456-459. doi: 10.1097/FTD.0000000000001192. Epub 2024 Mar 29.
Tacrolimus is the primary calcineurin inhibitor used in immunosuppressive regimens to prevent allograft rejection (AR) after organ transplantation. Recent studies have linked intrapatient variability (IPV) of tacrolimus with AR occurrence and reduced survival, especially in kidney transplant recipients. However, limited data are available on the impact of tacrolimus IPV on adverse outcomes after liver transplantation (LT).
The aim of this study was to assess the association between tacrolimus IPV using various methodologies with acute AR and long-term patient survival after LT.
All patients who underwent LT from January 2010 to July 2021 were retrospectively evaluated. Tacrolimus IPV was calculated for each patient using the mean and SD, mean absolute deviation (MAD), coefficient of variation (CV), and time in therapeutic range (TTR). These measures were then compared with AR within the first 24 months after LT and to long-term survival.
Out of 234 patients, 32 (13.7%) developed AR and 183 (78.2%) survived, with a mean follow-up of 101 ± 43 months. Tacrolimus IPV, assessed by mean, SD, MAD, and CV, was 8.3 ± 2.1, 2.7 ± 1.3, 32.0% ± 11.7%, and 39.4% ± 15.4%, respectively. There was no statistically significant correlation between Tacrolimus IPV and AR or survival post-LT.
In a large cohort of patients from diverse racial backgrounds, tacrolimus IPV was not associated with clinically relevant outcomes such as AR and survival after LT.
他克莫司是器官移植后预防移植物排斥反应（AR）的主要钙调神经磷酸酶抑制剂。最近的研究表明，他克莫司的患者内变异（IPV）与 AR 发生和生存减少有关，尤其是在肾移植受者中。然而，关于他克莫司 IPV 对肝移植（LT）后不良结局的影响，数据有限。
本研究旨在评估使用各种方法评估他克莫司 IPV 与 LT 后急性 AR 和长期患者生存的相关性。
回顾性评估了 2010 年 1 月至 2021 年 7 月期间接受 LT 的所有患者。使用均数和标准差、平均绝对偏差（MAD）、变异系数（CV）和治疗范围时间（TTR）计算每位患者的他克莫司 IPV。然后将这些指标与 LT 后 24 个月内的 AR 以及长期生存进行比较。
在 234 例患者中，32 例（13.7%）发生 AR，183 例（78.2%）存活，平均随访 101 ± 43 个月。通过均数、标准差、MAD 和 CV 评估的他克莫司 IPV 分别为 8.3 ± 2.1、2.7 ± 1.3、32.0% ± 11.7%和 39.4% ± 15.4%。他克莫司 IPV 与 LT 后 AR 或生存之间没有统计学上的显著相关性。
在来自不同种族背景的大量患者队列中，他克莫司 IPV 与 AR 和 LT 后生存等临床相关结局无关。
