Abstract: FR-PO1187
Weight-Based Dosing for Tacrolimus: A Single-Center Experience
Session Information
- Transplantation: Clinical - Immunosuppression, Adherence, Outcomes
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Katz-Greenberg, Goni, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
- Burke, Peter, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
- Singh, Pooja, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
Background
Tacrolimus (FK) remains the mainstay of maintenance immunosuppression for kidney transplant (KT) recipients. A therapeutic trough (TT) is maintained by dose adjustments within an acceptable narrow range. Low TTs are associated with acute rejection (AR) episodes. In order to address a wide variability in the initial prescribed dose, as well as issues with delayed time to TT, we implemented weight-based dosing (WBD) for FK in our center. Herein we present the results following this change.
Methods
For WBD, patients received FK at 0.1mg/kg/day on first post operation day (POD), with dose adjustments thereafter per standard protocol, for target TTs of 8-11ng/mL. Patients who underwent KT in the 6 months pre and post implementation of WBD were included in the analysis. We looked at baseline demographics, as well as donor and recipient characteristics. Rates of AR (per Banff 2017 criteria) at 90 days, serum creatinine (SCr) at 30 days, time to TT, and delayed graft function (DGF) were reviewed. Multi-organ txps, except kidney-pancreas were excluded.
Results
Following KT, 70 patients in the WBD cohort, and 68 patients in the cohort prior to the implementation [non WBD (nWBD)] were included. AR was seen in 7/65 of the WBD group, and in 3/56 of the nWBD group; p=0.281. On POD 3, the median FK TT was 8.5ng/mL in the WBD, versus 5.9ng/mL in the nWBD (figure 1). To avoid confounding, 38 live donor KT recipients were excluded from DGF analysis. In patients with deceased donor KT (DDKT), DGF rate was significantly higher in nWBD versus WBD group (19/41 [46.3%] vs 9/42 [21.4%], respectively; p<0.05). No difference in median SCr was noted.
Conclusion
FK levels are expected to reach a steady state after 3-4 doses. The WBD group achieved TTs earlier than the nWBD group. Significantly higher DGF rate was noted in the nWBD group, with similar rates of rejection in both groups. Further large-scale studies are needed to examine the role of WBD on DGF, AR and its effect on graft function, as well as costs in the immediate post txp period.
Figure 1