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Abstract: FR-PO791

Association Between Tacrolimus Level and Graft Outcome According to Bisphosphonate Use in Kidney Transplantation Patients

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Koh, Hee Byung, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Heo, Ga Young, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Kim, Hyo Jeong, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Jung, Chan-Young, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Kim, Hyung Woo, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Song, Seung Hwan, Ewha Womans University Seoul Hospital, Seoul, Korea (the Republic of)
  • Choi, Hoon Young, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
  • Yang, Jaeseok, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Huh, Kyu ha, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Kim, Beom Seok, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
Background

Although the introduction of tacrolimus significantly improved the prognosis of kidney transplantation (KT), an immunosuppressive drug that further improves the current prognosis has not yet been developed. Several recent studies have shown that bisphosphonate (BPP) use was associated with a favorable graft outcome in patients with KT. Therefore, we investigated whether the association between tacrolimus and graft outcome was different according to the use of BPP in patients with KT.

Methods

This retrospective study was conducted by analyzing 1,657 patients who underwent KT at Severance Hospital in South Korea between January 2006 and December 2020. Patients with preoperative BPP use, cyclosporine use, rapamycin use, re-transplantation, and missing information were excluded. Primary exposure was time-dependent cross-product term of tacrolimus trough level (low TAC vs. normal-high TAC with reference of 4ng/mL) and BPP use. Primary outcome was graft failure defined as patient’s death or conversion to kidney replacement therapy. Sensitivity analysis was performed with outcome of eGFR <30 ml/min/1.73 m<span style="font-size:10.8333px">2</span>

Results

Among 1,657 patients, 362 (21.8%) patients were BPP user. During the 11211.8 person-year, graft outcomes occurred in 183 (11.0%) patients. In multivariable Cox regression analysis, normal-high TAC without BPP was associated with a lower risk of graft outcome (HR, 0.40 [95% CI, 0.29-0.54]) compared to low TAC without BPP. Normal-high TAC with BPP was associated with a further lower risk of graft outcome (HR, 0.17 [95% CI, 0.09-0.31]) compared to low TAC without BPP. Low TAC with BPP was also associated with a lower risk of graft outcome (HR, 0.15 [95% CI, 0.06-0.36]) compared to low TAC without BPP. This association was maintained in analyses using tacrolimus trough level of 5 or 6 ng/mL as reference. In addition, similar results were observed with outcome of eGFR <30 ml/min/1.73 m<span style="font-size:10.8333px">2</span>

Conclusion

The use of BPP was associated with favorable graft outcomes even in lower tacrolimus trough level. The addition of BPP to the conventional immunosuppressant regimen may reduce tacrolimus requirement.