| High within-patient variability in the clearance of tacrolimus is a risk factor for poor long-term outcome after kidney transplantation. | |
| | |
MedLine Citation:
|
PMID: 20190242 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: We hypothesized that a high within-patient variability in clearance of tacrolimus and mycophenolate mofetil (MMF) would put patients at risk for periods of over- or underimmunosuppression and would thus lead to long-term chronic allograft nephropathy and graft loss after transplantation. METHODS: From 297 patients transplanted between 1 January 2000 and 31 December 2004, the within-patient variability in clearance was calculated from tacrolimus whole-blood concentrations and mycophenolic acid (MPA) plasma concentrations drawn between 6 and 12 months post-transplantation. As a primary outcome, a composite end point consisting of graft loss, biopsy-proven chronic allograft nephropathy and 'doubling in plasma creatinine concentration in the period between t = 12 months post-transplantation and last follow-up' was used. RESULTS: In the study population of 297 patients, 34 patients reached the primary end point of graft failure. The within-patient variability in the clearance of tacrolimus and three other covariates are significant risk factors for reaching the composite end point of failure [P-values for intraindividual tacrolimus variability = 0.003, biopsy-proven acute rejection (BPAR) = 0.003, recipient age at transplantation = 0.005]. The mean tacrolimus concentration for controls [7.4 (+/- 2.9) ng/mL] and for failures [6.9 (+/- 2.5) ng/mL] was similar. Within-patient variability in the clearance of MPA was not related to reaching the composite end point of failure. CONCLUSIONS: This study shows a significant relationship between the high within-patient variability in the clearance of tacrolimus, but not for MPA, and long-term graft failure. |
| | |
Authors:
|
Lennaert C P Borra; Joke I Roodnat; Judith A Kal; Ron A A Mathot; Willem Weimar; Teun van Gelder |
Publication Detail:
|
Type: Journal Article Date: 2010-02-26 |
Journal Detail:
|
Title: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Volume: 25 ISSN: 1460-2385 ISO Abbreviation: Nephrol. Dial. Transplant. Publication Date: 2010 Aug |
Date Detail:
|
Created Date: 2010-07-19 Completed Date: 2010-10-28 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8706402 Medline TA: Nephrol Dial Transplant Country: England |
Other Details:
|
Languages: eng Pagination: 2757-63 Citation Subset: IM |
Affiliation:
|
Department of Hospital Pharmacy, Molewaterplein 40, Rotterdam, The Netherlands. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Female Graft Rejection / blood, epidemiology* Humans Kidney Transplantation* Male Middle Aged Mycophenolic Acid / analogs & derivatives*, blood Predictive Value of Tests Regression Analysis Retrospective Studies Risk Factors Tacrolimus / blood* Transplantation, Homologous Treatment Outcome |
| Chemical | |
Reg. No./Substance:
|
109581-93-3/Tacrolimus; 128794-94-5/mycophenolate mofetil; 24280-93-1/Mycophenolic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Sex-specific association of time-varying haemoglobin values with mortality in incident dialysis pati...
Next Document: Intradialytic exercise training reduces oxidative stress and epicardial fat: a pilot study.