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Kidney Week

Abstract: PO2525

Health System Encounters in Kidney Transplant Recipients Converted from Immediate-Release Tacrolimus Capsules to Extended-Release Tacrolimus Tablets

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Ha, Yoonhee P., Department of Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Rashid, Jamal, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Putt, Mary, Department of Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Na, Yu Bin, Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Sammons, Chelsea, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Norris, Maxwell, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Malat, Gregory, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Steiner, Brendan, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Holmes, John H., Department of Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Bloom, Roy D., Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Reese, Peter P., Department of Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Trofe-Clark, Jennifer, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background

Kidney transplant recipients (KTRs) converted from immediate-release tacrolimus capsules (IR-TAC) to extended-release tacrolimus tablets (ER-TAC) may benefit from reduced dosing frequency and improved bioavailability. However, few studies have characterized health system encounters in these KTRs. Study aims were to (1) determine if conversion to ER-TAC decreased number of dose changes, TAC troughs, and transplant clinic visits and (2) characterize number of dose changes and days to achieve two consecutive therapeutic troughs (5-12 ug/L) under ER-TAC.

Methods

Retrospective review of KTRs at our center transplanted between 2/2010-3/2019, on IR-TAC for ≥90 days, and converted to ER-TAC for ≥90 days. Random-coefficient Poisson regression was used to compare number of dose changes, troughs, and clinic visits during the 90-day periods pre- and post-conversion.

Results

64 KTRs met inclusion criteria. Mean (SD) age was 52.8 (13.7) years. 38 (59%) were male, 28 (44%) were Black, and 8 (13%) were in an ER-TAC financial assistance program. Median (IQR) time since transplant was 533 (211-1,483) days.

KTRs were converted for tremor, 26 (41%); non-adherence, 12 (19%); high IR-TAC dose, 2 (3%); sub-therapeutic troughs, 2 (3%); and other/unknown, 22 (34%).

The incidence rate of dose changes but not troughs or clinic visits decreased significantly post-conversion (Table).

For the 24 (38%) KTRs with two consecutive therapeutic troughs within 90 days, median (IQR) number of dose changes was 2 (0-1) and days to achieve two consecutive therapeutic troughs was 33.5 (23.5-63).

Conclusion

The incidence rate of dose changes decreased significantly under ER-TAC, but most KTRs did not achieve two consecutive therapeutic troughs within 90 days of conversion. Closer follow up may be beneficial for these KTRs. Future research should determine if reasons for conversion resolved with ER-TAC.

 IR-TAC (90 days)ER-TAC (90 days) 
Median no.IQRMedian no.IQRAdjusted IRR*95% CIP-value
Dose changes11-10.50-20.590.40-0.890.011
TAC troughs2.51-742-61.070.86-1.330.551
Transplant clinic visits10-210-20.760.55-1.060.104

* Adjusted for age, sex, race, financial assistance, conversion reason, time since transplant, and achievement of two consecutive therapeutic troughs