Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients
- Authors
- Jung, H.-Y.; Seo, M.Y.; Jeon, Y.; Huh, K.H.; Park, J.B.; Jung, C.W.; Lee, S.; Han, S.-Y.; Ro, H.; Yang, J.; Ahn, C.; Choi, J.-Y.; Cho, J.-H.; Park, S.-H.; Kim, Y.-L.; Kim, C.-D.
- Issue Date
- Jul-2020
- Publisher
- PUBLIC LIBRARY SCIENCE
- Citation
- PloS one, v.15, no.7, pp.e0235418
- Journal Title
- PloS one
- Volume
- 15
- Number
- 7
- Start Page
- e0235418
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/76178
- DOI
- 10.1371/journal.pone.0235418
- ISSN
- 1932-6203
- Abstract
- BACKGROUND: Little is known regarding optimal tacrolimus (TAC) trough levels after 1 year post-transplant in stable kidney transplant recipients (KTRs) who have not experienced renal or cardiovascular outcomes. This study aimed to investigate the effect of 1-year post-transplant TAC trough levels on long-term renal and cardiovascular outcomes and opportunistic infections in stable KTRs. METHODS: KTRs receiving TAC with mycophenolate-based immunosuppression who did not experience renal or cardiovascular outcomes within 1 year post-transplant were enrolled from a multicenter observational cohort study. Renal outcome was defined as a composite of biopsy-proven acute rejection, interstitial fibrosis and tubular atrophy, and death-censored graft loss. Cardiovascular outcome was defined as a composite of de novo cardiomegaly, left ventricular hypertrophy, and cardiovascular events. Opportunistic infections were defined as the occurrence of BK virus or cytomegalovirus infections. RESULTS: A total of 603 eligible KTRs were divided into the low-level TAC (LL-TAC) and high-level TAC (HL-TAC) groups based on a median TAC level of 5.9 ng/mL (range 1.3-14.3) at 1 year post-transplant. The HL-TAC group had significantly higher TAC trough levels at 2, 3, 4, and 5 years compared with the levels of the LL-TAC group. During the mean follow-up of 63.7 ± 13.0 months, there were 121 renal outcomes and 224 cardiovascular outcomes. In multivariate Cox regression analysis, LL-TAC and HL-TAC were not independent risk factors for renal and cardiovascular outcomes, respectively. No significant differences in the development of opportunistic infections and de novo donor-specific anti-human leukocyte antigen antibodies and renal allograft function were observed between the two groups. CONCLUSIONS: TAC trough levels after 1 year post-transplant remained at a similar level until the fifth year after kidney transplantation and were not directly associated with long-term outcomes in stable Korean KTRs who did not experience renal or cardiovascular outcomes. Therefore, in Asian KTRs with a stable clinical course, TAC trough levels higher than approximately 6 ng/mL might not be required after a year of kidney transplantation.
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