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Kidney Week

Abstract: FR-PO1181

Impact of 1-Year Post-Transplant Tacrolimus Trough Levels on Long-Term Renal and Cardiovascular Outcomes in Stable Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Jung, Hee-Yeon, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Choi, Ji-Young, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Cho, Jang-Hee, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Park, Sun-Hee, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Kim, Yong-Lim, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Kim, Chan-Duck, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
Background

This study aimed to investigate the impact of 1-year post-transplant tacrolimus (TAC) trough levels on renal and cardiovascular outcomes in stable kidney transplant recipients (KTRs).

Methods

KTRs receiving TAC and mycophenolate-based immunosuppression who have never experienced renal or cardiovascular events within 1-year post-transplant were included from a multicenter observational cohort study. Renal outcome was defined as a composite of biopsy-proven acute rejection, interstitial fibrosis and tubular atrophy, and death censored graft loss. Cardiovascular outcome was defined as a composite of de novo cardiomegaly, left ventricular hypertrophy, and cardiovascular events.

Results

A total of 603 eligible KTRs were divided into low-level (LL) and high-level (HL) TAC based on the median TAC level at 1-year post-transplant of 5.9 ng/mL (range 1.3-14.3). During the mean follow-up of 38.2 ± 13.0 months, 27 and 166 episodes of renal and cardiovascular outcomes occurred, respectively. In multivariate Cox regression analysis, LL-TAC and HL-TAC were not independent risk factors for renal and cardiovascular outcomes, respectively. Instead, deceased donor KT (adjusted hazard ratio [AHR], 2.52; 95% confidence interval [CI], 1.10–6.01; P = 0.037) and male (AHR, 1.62; 95% CI, 1.06–2.47; P = 0.025) were independent risk factors for renal and cardiovascular outcomes, respectively. No significant differences in estimated glomerular filtration rate at 2- and 3-year post-transplant were observed between two groups.

Conclusion

TAC trough levels after 1-year post-transplant were not directly related to long-term renal and cardiovascular events in stable KTRs. There might be no need to insist higher TAC trough levels after 1-year post-transplant in KTRs with stable post-transplant clinical course.