Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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The Effects of Intrapatient Variability in Tacrolimus Concentration on Clinical Outcomes Immediately After Liver Transplantation

Tacrolimus의 혈중농도 변동성이 간이식 예후에 미치는 영향

  • Kim, Eunji (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Kim, Boram (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Cho, Jungwon (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Lee, Jung Hwa (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Lee, Eunsook (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Yu, Yun Mi (Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei Unversity) ;
  • Cho, Jai Young (Department of Surgery, Seoul National University College of Medicine & Seoul National University Bundang Hospital) ;
  • Lee, Euni (College of Pharmacy & Research Institute of Pharmaceutical Science, Seoul National University) ;
  • Choi, YoungRok (Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital)
  • 김은지 (분당서울대학교병원 약제부) ;
  • 김보람 (분당서울대학교병원 약제부) ;
  • 조정원 (분당서울대학교병원 약제부) ;
  • 이정화 (분당서울대학교병원 약제부) ;
  • 이은숙 (분당서울대학교병원 약제부) ;
  • 유윤미 (연세대학교 약학대) ;
  • 조재영 (분당서울대학교병원 외과) ;
  • 김은경 (서울대학교 약학대학) ;
  • 최영록 (서울대학교병원 외과)
  • Received : 2019.11.29
  • Accepted : 2020.03.10
  • Published : 2020.03.31
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Abstract

Background: Tacrolimus, a calcineurin inhibitor, is an immunosuppressant used in post-transplantation maintenance therapy. The drug has a narrow therapeutic range and requires periodic therapeutic drug monitoring. Although many studies have reported the effects of intrapatient variability of tacrolimus on survival, rejection, and complications in renal transplant recipients, very few studies have reported these effects in liver transplant recipients. The purpose of this study was to evaluate the effect of intrapatient variability of tacrolimus on clinical outcomes after liver transplantation. Methods: Intrapatient variability was calculated using individual, averaged tacrolimus concentrations. Patients were divided into two groups according to their median variability value: high-variability and low-variability groups. The rate of deviation from the therapeutic range, incidence of acute rejection, post-transplant diabetes, incidence of infection, and estimated glomerular filtration rate (eGFR) after transplantation were compared between the groups. Results: Of the total patients (n=82), the high-variability group (n=41) exhibited significantly greater deviation from the therapeutic range (65.92% vs. 56.84%; p<0.001). There was no significant difference in acute rejection or post-transplantation diabetes incidence or eGFR; however, the number of infection in the first 6 months was significantly lower in the low-variability group (0.4 vs. 0.9 times; p=0.039). Multiple linear regression analysis showed that the number of infection significantly increased as intrapatient variability increased (p=0.015). Conclusion: High intrapatient variability in tacrolimus concentrations was strongly associated with an increased frequency of deviation from the suggested therapeutic range and an increased number of infection.

Keywords

References

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