Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk

Abstract High intra-patient variability (IPV) of tacrolimus trough concentrations is increasingly recognized as a predictor of poor long-term outcomes in kidney transplant. However, there is a lack of information regarding the association between tacrolimus IPV and graft outcomes according to immuno...

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Autores principales:	Eun Jin Kim, Soo Jin Kim, Kyu Ha Huh, Beom Seok Kim, Myoung Soo Kim, Soon Il Kim, Yu Seun Kim, Juhan Lee
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/aa56608f5d0e4aaa9bab94b3baf9ec36
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spelling	oai:doaj.org-article:aa56608f5d0e4aaa9bab94b3baf9ec362021-12-02T17:47:04ZClinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk10.1038/s41598-021-91630-42045-2322https://doaj.org/article/aa56608f5d0e4aaa9bab94b3baf9ec362021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-91630-4https://doaj.org/toc/2045-2322Abstract High intra-patient variability (IPV) of tacrolimus trough concentrations is increasingly recognized as a predictor of poor long-term outcomes in kidney transplant. However, there is a lack of information regarding the association between tacrolimus IPV and graft outcomes according to immunological risk. We analyzed tacrolimus IPV using the coefficient of variability from months 6–12 after transplantation in 1080 kidney transplant recipients. Patients were divided into two immunological risk groups based on pre-transplant panel reactive antibodies and donor-specific antibodies. High immunological risk was defined as panel reactive antibodies ≥ 20% or the presence of donor-specific antibodies. The effects of tacrolimus IPV on graft outcomes were significantly different between low and high immunological risk patients. A multivariable Cox regression model confirmed that high tacrolimus IPV was an independent risk factor for graft failure in the high risk group (HR, 2.90; 95% CI, 1.42–5.95, P = 0.004). In the high risk group, high tacrolimus IPV was also significantly associated with increased risk of antibody-mediated rejection (P = 0.006). In contrast, death-censored graft survival and antibody-mediated rejection in the low immunological risk group was not significantly different by tacrolimus IPV. High tacrolimus IPV significantly increases the risk of graft failure and antibody-mediated rejection in patients with high immunological risk.Eun Jin KimSoo Jin KimKyu Ha HuhBeom Seok KimMyoung Soo KimSoon Il KimYu Seun KimJuhan LeeNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Eun Jin Kim Soo Jin Kim Kyu Ha Huh Beom Seok Kim Myoung Soo Kim Soon Il Kim Yu Seun Kim Juhan Lee Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk
description	Abstract High intra-patient variability (IPV) of tacrolimus trough concentrations is increasingly recognized as a predictor of poor long-term outcomes in kidney transplant. However, there is a lack of information regarding the association between tacrolimus IPV and graft outcomes according to immunological risk. We analyzed tacrolimus IPV using the coefficient of variability from months 6–12 after transplantation in 1080 kidney transplant recipients. Patients were divided into two immunological risk groups based on pre-transplant panel reactive antibodies and donor-specific antibodies. High immunological risk was defined as panel reactive antibodies ≥ 20% or the presence of donor-specific antibodies. The effects of tacrolimus IPV on graft outcomes were significantly different between low and high immunological risk patients. A multivariable Cox regression model confirmed that high tacrolimus IPV was an independent risk factor for graft failure in the high risk group (HR, 2.90; 95% CI, 1.42–5.95, P = 0.004). In the high risk group, high tacrolimus IPV was also significantly associated with increased risk of antibody-mediated rejection (P = 0.006). In contrast, death-censored graft survival and antibody-mediated rejection in the low immunological risk group was not significantly different by tacrolimus IPV. High tacrolimus IPV significantly increases the risk of graft failure and antibody-mediated rejection in patients with high immunological risk.
format	article
author	Eun Jin Kim Soo Jin Kim Kyu Ha Huh Beom Seok Kim Myoung Soo Kim Soon Il Kim Yu Seun Kim Juhan Lee
author_facet	Eun Jin Kim Soo Jin Kim Kyu Ha Huh Beom Seok Kim Myoung Soo Kim Soon Il Kim Yu Seun Kim Juhan Lee
author_sort	Eun Jin Kim
title	Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk
title_short	Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk
title_full	Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk
title_fullStr	Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk
title_full_unstemmed	Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk
title_sort	clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/aa56608f5d0e4aaa9bab94b3baf9ec36
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Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk

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