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Abstract: SA-PO517

Comparing Long-Term Blood Pressure Management in Kidney Transplant Patients: Immediate-Release vs. Extended-Release Tacrolimus

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Yang, Chien-Wen, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Cohen, Debbie L., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Tacrolimus (Tac) is a first-line anti-rejection medication with immediate-release (Tac IR) and extended-release (Tac ER) versions. Hypertension is a common adverse effect of Tac, but the longitudinal blood pressure control between kidney transplant recipients receiving Tac ER and Tac IR has never been studied.


A retrospective, single-center cohort study used data from the University of Pennsylvania Health System. Adult patients aged 18+ who started tacrolimus immediately after kidney transplantation between January 1st, 2016, and December 31st, 2019, were included. The primary outcome was time-varying systolic and diastolic blood pressure (SBP and DBP) documented through December 31st, 2021. Baseline and time-varying variables were collected, and the secondary outcome was the incidence of hypertensive crisis. Sensitivity analysis was performed using time-constant exposure based on the type of Tac patients received at four months post-transplant. A logistic regression model, a 3-step marginal structural model, and a 2-tailed Fisher’s exact test were used for analysis.


654 patients with 16,382 BP entries were analyzed. Black patients were 2.32 times more likely to receive Tac ER (p=0.001). Patients taking Tac ER had a 1.87 mmHg lower SBP than those taking Tac IR (p=0.009), but no difference in SBP in the sensitivity analysis with a time-constant exposure at a 4-month cutoff. No significant differences were observed in DBP in both the main and sensitivity analyses. A total of 9 patients experienced a hypertension crisis; 8 were on Tac IR, and 1 was on Tac ER. No statistical difference in the occurrence of hypertension crises between the two groups was found.


Post-transplant patients taking Tac ER show a slightly lower SBP than those on Tac IR, without a significant difference in hypertensive crisis incidence.


  • Other NIH Support