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Gueta I, Markovits N, Yarden-Bilavsky H, Raichlin E, Freimark D, Lavee J, Loebstein R, Peled Y. High tacrolimus trough level variability is associated with rejections after heart transplant. Am J Transplant 2018; 18:2571-2578. [PMID: 29989311 DOI: 10.1111/ajt.15016] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/11/2018] [Accepted: 07/01/2018] [Indexed: 01/25/2023]
Abstract
Tacrolimus, the major immunosuppressant after heart transplant (HTx) therapy, is a narrow therapeutic index drug. Hence, achieving stable therapeutic steady state plasma concentrations is essential to ensure efficacy while avoiding toxicity. Whether high variability in steady state concentrations is associated with poor outcomes is unknown. We investigated the association between tacrolimus trough level variability during the first year post-HTx and outcomes during and beyond the first postoperative year. Overall, 72 patients were analyzed for mortality, of whom 65 and 61 were available for rejection analysis during and beyond the first year post-HTx, respectively. Patients were divided into high (median >28.8%) and low tacrolimus level variability (<28.8%) groups. Mean tacrolimus levels did not differ between the groups (12.7 ± 3.4 ng/mL vs 12.8 ± 2.4 ng/mL, P = .930). Patients in the high variability group exhibited higher long-term rejection rate (median total rejection score: 0.33 vs 0, P = .04) with no difference in rejection scores within the first year post-HTx. Multivariate analysis showed that high tacrolimus trough level variability was associated with >8-fold increased risk for any rejection beyond the first year post-HTx (P = .011). Mortality was associated only with cardiovascular complications (P = .018), with no effect of tacrolimus through level variability.
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Affiliation(s)
- Itai Gueta
- The Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Markovits
- The Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Havatzelet Yarden-Bilavsky
- The Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eugenia Raichlin
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dov Freimark
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Lavee
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Ronen Loebstein
- The Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Peled
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Olga and Lev Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
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