Pharmacy, Children's Hospital Colorado, Aurora, Colorado, USA.
Pharmacy, UNC Health, Chapel Hill, North Carolina, USA.
Clin Transplant. 2024 Aug;38(8):e15417. doi: 10.1111/ctr.15417.
Limited published experience describes once daily, extended-release tacrolimus (LCP-Tac) use in pediatric solid organ transplantation (SOT), particularly nonrenal SOT. LCP-Tac can simplify immunosuppression (IS) regimens, minimize immediate release-tacrolimus (IR-Tac)-associated adverse effects, and promote adherence. This study describes the successful use of LCP-Tac in adolescent and young adult (AYA) SOT populations.
A single-center, retrospective chart review of AYA SOT recipients (age < 25 years) converted from IR-Tac to LCP-Tac. Graft survival, biopsy-proven acute rejection (BPAR), infection rates, estimated glomerular filtration rate (eGFR), and pill burden were assessed at five time points postconversion (1, 3, 6, 12, and 24 months). Intrapatient variability of tacrolimus, as assessed by coefficient of variability (CV%), was also analyzed.
Twenty-nine AYA SOT recipients (19 heart, 6 kidney, and 4 liver) were converted to LCP-Tac, with a median age of 17.4 years at conversion. Conversion, mainly due to perceived or identified medication nonadherence, occurred at a median of 5.4 years posttransplant. No graft loss occurred within 24 months of conversion, and BPAR incidence rate was consistent with previous reports for these populations. Only one patient experienced CMV infection. Renal function remained stable postconversion.
Successful conversion from IR-Tac to LCP-Tac was demonstrated in AYA heart, kidney, and liver transplant recipients. These AYA SOT recipients experienced reduced pill burden and improved tacrolimus trough concentration variability. However, the impact on medication adherence warrants further investigation. Future research should explore the targeted use of LCP-Tac to enhance IS tolerability and medication adherence in young SOT populations.
有限的已发表经验描述了在儿科实体器官移植（SOT）中，特别是非肾脏 SOT 中，每日一次的延长释放他克莫司（LCP-Tac）的使用。LCP-Tac 可以简化免疫抑制（IS）方案，最大限度地减少即时释放他克莫司（IR-Tac）相关的不良反应，并提高依从性。本研究描述了 LCP-Tac 在青少年和年轻成人（AYA）SOT 人群中的成功应用。
对从 IR-Tac 转换为 LCP-Tac 的 AYA SOT 受者（年龄<25 岁）进行了单中心、回顾性图表审查。在转换后的五个时间点（1、3、6、12 和 24 个月）评估移植物存活率、活检证实的急性排斥反应（BPAR）、感染率、估计肾小球滤过率（eGFR）和药丸负担。还分析了 Tacrolimus 的个体内变异，用变异系数（CV%）评估。
29 例 AYA SOT 受者（19 例心脏、6 例肾脏和 4 例肝脏）转换为 LCP-Tac，转换时的中位年龄为 17.4 岁。转换主要是由于认为或发现药物不依从，发生在移植后的中位数为 5.4 年。转换后 24 个月内无移植物丢失，BPAR 发生率与这些人群的先前报告一致。只有 1 例患者发生 CMV 感染。转换后肾功能保持稳定。
在 AYA 心脏、肾脏和肝脏移植受者中成功地从 IR-Tac 转换为 LCP-Tac。这些 AYA SOT 受者的药丸负担减少，Tacrolimus 谷浓度变异性改善。然而，药物依从性的影响需要进一步研究。未来的研究应该探索 LCP-Tac 的靶向使用，以提高年轻 SOT 人群的 IS 耐受性和药物依从性。
