Relationship between high intra-patient variability of tacrolimus and transplant outcome in renal transplant recipients

doi:10.3877/cma.j.issn.2095-5820.2019.02.006

Abstract

Abstract:

Objective

To investigate whether intra-patient variability (IPV) of tacrolimus (Tac) is closely related to chronic graft dysfunction in renal transplant recipients.

Methods

A total of 1167 renal transplant recipients were enrolled in this study. Their surgical operations were carried out during January 2009 and December 2016 in West China Hospital of Sichuan University. Tac IPV was obtained from whole blood during 7 and 12 months after transplantation. Set outcomes (including endpoints) include: (1) graft failure, retransplantation, (re) start dialysis, or glomerular filtration rate (eGFR) less than 15 ml/min, biopsy-proven acute rejection (BPAR); (2) histologically confirmed glomerulopathy; (3)12 months after transplantation to during the last follow-up period, serum creatinine concentration was doubled; (4) the last follow-up. The renal function, survival time and chronic graft failure of renal transplant recipients in different IPV groups were analyzed.

Results

Of the 1167 patients in this study, 79 (6.8%) reached the end point of graft failure. The mean value of Tac IPV in 7~12 months after transplantation was 25.7%. Serum creatinine was significantly higher in 15 months after transplantation in the high IPV group than in the low IPV group (P < 0.05), and eGFR was significantly lower in the 15, 21, 24 months after transplantation in the high IPV group than in the low IPV group (P < 0.05). Multivariate Cox regression analysis showed that Tac IPV had some effect on predicting the prognosis of renal transplantation, but it was not significant (P=0.051, Harzards ratio=1.015, 95%CI: 1.000-1.031). The recipients′ age, sex and graft function at 6 months after transplantation were independent predictors of graft survival.

Conclusion

High Tac IPV is clinically associated with graft failure in renal transplant recipient and is an important medical indicator for predicting renal function in renal transplant recipients within two years after transplantation.

Key words: Tacrolimus, Intra-patient variability, Renal transplantation

Jianjun Ma, Yao Chen, Yamei Li, Yangjuan Bai, Yuangao Zou, Jiangtao Tang. Relationship between high intra-patient variability of tacrolimus and transplant outcome in renal transplant recipients[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2019, 07(03): 156-161.

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Figures/Tables 6

References 20

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?		人数/总人数	信息
受者性别		?	?
?	男	839/1167	71.9%
?	女	328/1167	28.1%
受者年龄(岁)		1165/1167	33.19(13~66)
受者民族		?	?
?	汉族	1063/1167	91.1%
?	藏族	56/1167	4.8%
?	彝族	29/1167	2.5%
?	其他少数民族	19/1167	1.6%
供体类型		?	?
?	活体	1004/1167	86%
?	遗体	163/1167	14%
移植时间		?	?
?	2009-2012	254/1167	21.8%
?	2013-2016	913/1167	78.2%
移植后6月血清肌酐(umol/L)		1162/1167	108.6(40.0~410.0)
移植后6月血清eGFR(ml/min/1.73 m²)		1160/1167	79.4(13.3~146)
Tac mean (ng/mL)		1167	5.55(2.25~12.03)

?		人数/总人数	信息
受者性别		?	?
?	男	839/1167	71.9%
?	女	328/1167	28.1%
受者年龄(岁)		1165/1167	33.19(13~66)
受者民族		?	?
?	汉族	1063/1167	91.1%
?	藏族	56/1167	4.8%
?	彝族	29/1167	2.5%
?	其他少数民族	19/1167	1.6%
供体类型		?	?
?	活体	1004/1167	86%
?	遗体	163/1167	14%
移植时间		?	?
?	2009-2012	254/1167	21.8%
?	2013-2016	913/1167	78.2%
移植后6月血清肌酐(umol/L)		1162/1167	108.6(40.0~410.0)
移植后6月血清eGFR(ml/min/1.73 m²)		1160/1167	79.4(13.3~146)
Tac mean (ng/mL)		1167	5.55(2.25~12.03)

?	P值	风险指数(95%CI)
受者性别	0.011	0.462(0.255-0.333)
受者年龄	0.131	0.980(0.956-1.006)
受者民族	0.407	1.184(0.794-1.766)
供体类型	0.072	1.810(0.949-3.454)
移植后6月血清肌酐	0.001	1.009(1.004-1.014)
移植后6月血清eGFR	0.006	0.983(0.972-0.995)
Tac IPV	0.043	1.016(1.001-1.031)

?	P值	风险指数(95%CI)
受者性别	0.011	0.462(0.255-0.333)
受者年龄	0.131	0.980(0.956-1.006)
受者民族	0.407	1.184(0.794-1.766)
供体类型	0.072	1.810(0.949-3.454)
移植后6月血清肌酐	0.001	1.009(1.004-1.014)
移植后6月血清eGFR	0.006	0.983(0.972-0.995)
Tac IPV	0.043	1.016(1.001-1.031)

?	P值	风险指数(95%CI)
Tac IPV	0.051	1.015(1.000-1.031)
受者性别	0.013	0.382(0.179-0.815)
受者年龄	0.014	0.965(0.938-0.993)
供体类型	0.088	1.763(0.919-3.382)
移植后6月血清肌酐	0.540	0.996(0.984-1.008)
移植后6月血清eGFR	0.019	0.977(0.959-0.996)

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