07 August 2013
Evolution to twice daily bolus intravenous tacrolimus: Optimizing efficacy and safety of calcineurin inhibitor delivery early post lung transplantGregory I. SnellABCDEFG, Steven IvulichABCDEF, Lauren MitchellABC, Glen P. WestallDEF, Bronwyn J. LevveyABDEF
Ann Transplant 2013; 18:399-407
Achieving therapeutic levels of cyclosporine (CSA) or Tacrolimus (TAC) early post lung transplantation (LTx) is challenging. Gut dysmotility, renal dysfunction and seizure risk are variably present and problematic. This study reports a single center.
Material and Methods
All adult LTx recipients from Aug 06–Aug 11 were divided into 4 cohorts: A) intravenous (IV) CSA twice daily (BD) 6 hr bolus then oral CSA, n=63; B) sub-lingual (SL) TAC BD then oral TAC, n=90; C) oral TAC BD, n=18; and D) IV TAC BD 4hr bolus then oral TAC, n=62. CSA/TAC trough levels were measured at days 1–7, 14 and 28 aiming for target trough levels >250 ng/ml and >8ng/ml respectively.
There were no differences in demographics, ICU and total length of stay between groups. Target trough levels were achieved in 13%*#, 26%*, 17% and 37%# of patients for Groups A-D respectively, (*#p<0.05) by day 7, increasing to 65%, 74%, 88% and 72% by day 14 (p=ns). Acute rejection at day 14 was seen in 3%*, 6%, 17%* and 5% respectively (*p<0.05) Acute rejection <90days was noted in 15%, 17%, 22% and 11% respectively (p=ns). No significant difference in neurotoxicity or acute nephrotoxicity was apparent across the groups.
Early post LTx, SL and oral routes of immunosuppressive administration are less efficacious than intravenous. BD bolus IV TAC achieved significantly higher target levels earlier, with correspondingly lower acute rejection rates and acceptable safety of administration.
Keywords: Lung Transplantation, acute rejection, Tacrolimus
20 Jan 2022 : Original articleImpact on Waitlist Outcomes from Changes in the Medical Eligibility of Candidates for Simultaneous Liver-Ki...
Ann Transplant In Press; DOI: 10.12659/AOT.934850
19 Jan 2022 : Original articleCarbohydrate Metabolism Disorders in Relation to Cardiac Allograft Vasculopathy (CAV) Intensification in He...
Ann Transplant In Press; DOI: 10.12659/AOT.933420
18 Jan 2022 : Original articlePLGA+Fe₃O₄+PFP Nanoparticles Drug-Delivery Demonstrates Potential Anti-Tumor Effects on Tumor Cells
Ann Transplant In Press; DOI: 10.12659/AOT.933246
Most Viewed Current Articles
29 Dec 2021 : Original articleEfficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...
Ann Transplant 2021; 26:e933588
22 Dec 2021 : Original articleComparison of Coronary Artery Calcium Scoring with Dobutamine Stress Echo for Detection of Coronary Artery ...
Ann Transplant 2021; 26:e934163
12 Jan 2022 : Original articleRisk Factors for Developing BK Virus-Associated Nephropathy: A Single-Center Retrospective Cohort Study of ...
Ann Transplant 2022; 27:e934738