Yang Chien-Wen, Velez Juan Carlos Q, Cohen Debbie L
Department of Nephrology, Ochsner Medical Center, New Orleans, Louisiana, USA.
Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia.
Nephron. 2025;149(2):57-65. doi: 10.1159/000541334. Epub 2024 Sep 22.
Hypertension (HTN) is a common side effect of tacrolimus (Tac), the first-line antirejection medication for kidney transplant recipients. The impact of immediate-release tacrolimus (Tac IR) dosed twice daily versus extended-release tacrolimus (Tac ER) dosed once daily on long-term blood pressure control in kidney transplant recipients remains understudied. This study aims to compare the use of Tac IR versus Tac ER in kidney transplant recipients and evaluate the effects of the different formulations on systolic blood pressure (SBP), diastolic blood pressure (DBP), and HTN crisis.
This retrospective cohort study at a single institution collected baseline characteristics, time-varying exposure to Tac IR versus Tac ER, SBP, DBP, HTN crisis, and confounders at each posttransplant visit. A marginal structural linear mixed-effects model was employed to analyze the longitudinal blood pressure control in kidney transplant recipients receiving Tac IR and Tac ER.
The final analysis included 654 patients, with mean ages of 52.0 years for Tac IR and 50.3 years for Tac ER. Males constituted 56.7% in Tac IR and 55.0% in Tac ER. Notably, the black population had 2.44 times higher odds of receiving Tac ER after adjusting for the rest of the baseline characteristics. No difference was found between longitudinal SBP (p = 0.386, 95% CI: -1.00, 2.57) or DBP (p = 0.797, 95% CI: -1.38, 1.06).
Our study indicates that posttransplant patients taking Tac ER exhibit no difference in chronic SBP and DBP controls compared to Tac IR.
高血压（HTN）是肾移植受者一线抗排斥药物他克莫司（Tac）的常见副作用。一日两次给药的速释他克莫司（Tac IR）与一日一次给药的缓释他克莫司（Tac ER）对肾移植受者长期血压控制的影响仍未得到充分研究。本研究旨在比较肾移植受者中Tac IR与Tac ER的使用情况，并评估不同剂型对收缩压（SBP）、舒张压（DBP）和高血压危象的影响。
在单一机构进行的这项回顾性队列研究收集了基线特征、随时间变化的Tac IR与Tac ER暴露情况、SBP、DBP、高血压危象以及每次移植后随访时的混杂因素。采用边际结构线性混合效应模型分析接受Tac IR和Tac ER的肾移植受者的纵向血压控制情况。
最终分析纳入654例患者，Tac IR组的平均年龄为52.0岁，Tac ER组为50.3岁。Tac IR组男性占56.7%，Tac ER组男性占55.0%。值得注意的是，在调整了其余基线特征后，黑人接受Tac ER的几率高出2.44倍。纵向SBP（p = 0.386，95% CI：-1.00，2.57）或DBP（p = 0.797，95% CI：-1.38，1.06）之间未发现差异。
我们的研究表明，与Tac IR相比，接受Tac ER的移植后患者在慢性SBP和DBP控制方面没有差异。
