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Tacrolimus monitoring parameters are not associated with acute cellular rejection following lung transplantation

  • Pharmacokinetics and Disposition
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the impact of tacrolimus drug monitoring parameters on the incidence of acute cellular rejection (ACR) in lung transplant recipients (LTRs).

Methods

This was a retrospective study of patients who underwent lung transplantation at a single center. LTRs who were given tacrolimus during the first 6 months after transplantation and who underwent at least one bronchoscopy with biopsy were included. Tacrolimus time in therapeutic range (TTR) was calculated using Rosendaal’s method. Time to therapeutic level, coefficient of variance (CoV), and median trough concentrations were also determined.

Results

The study included 157 LTRs. ACR ≥ A1 grade was present in 46.5% of patients, and ACR ≥ A2 grade was present in 17.2%. There was no difference between tacrolimus TTR in patients with ACR ≥ A1 compared with those without ACR (47.4 ± 16.1 versus 46.2 ± 18.9%, p = 0.67) or in patients with ACR ≥ A2 grade compared with those with A0 or A1 ACR (46.0 ± 16.3 versus 47.0 ± 17.9%, p = 0.81). When comparing patients with any ACR grade A1 or higher with those without ACR, there was no difference in tacrolimus CoV (42.7 ± 11.0 versus 44.6 ± 12.4, p = 0.30), median tacrolimus trough concentration (9.9 ± 1.3 versus 9.8 ± 1.4 ng/mL, p = 0.66), or days to therapeutic level (9 versus 12 days, p = 0.057).

Conclusions

The results suggest that tacrolimus TTR, time in therapeutic range, and variability are not related to the presence of ACR in LTRs.

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Authors and Affiliations

  1. Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Christina C. Kao, Justin Segraves & Amit D. Parulekar

  2. Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, 1161 21st Ave South, T1218 MCN, Nashville, TN, 37232, USA

    Amit D. Parulekar

Authors
  1. Christina C. Kao
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  2. Justin Segraves
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  3. Amit D. Parulekar
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Contributions

All authors contributed to study conception and design. Data collection was performed by Christina Kao and Justin Segraves. The first draft of the manuscript was prepared by Christina Kao and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Amit D. Parulekar.

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The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Institutional Review Board of Baylor College of Medicine with waiver of consent.

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Kao, C.C., Segraves, J. & Parulekar, A.D. Tacrolimus monitoring parameters are not associated with acute cellular rejection following lung transplantation. Eur J Clin Pharmacol 77, 63–69 (2021). https://doi.org/10.1007/s00228-020-02976-z

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  • DOI: https://doi.org/10.1007/s00228-020-02976-z

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