期刊
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY
卷 75, 期 7, 页码 951-958出版社
SPRINGER HEIDELBERG
DOI: 10.1007/s00228-019-02643-y
关键词
Kidney transplantation; Tacrolimus; Trough levels; Variability; Graft survival
资金
- none [none] Funding Source: Medline
PurposeHigh tacrolimus trough drug level variability was found to be associated with reduced graft survival. The primary goal of this study was to find whether reduction of exposure to high tacrolimus trough level variability in patients in which previously had high variability was associated with better graft survival.MethodsAll tacrolimus drug level values in patients that underwent kidney transplantation at our center between 2006 and 2015 were collected. Exposure to variability was calculated using a time-weighted coefficient of variability (TWCV). Time-dependent univariate and multivariate Cox proportional hazard models were used to analyze the primary outcome of graft survival and to determine a cutoff value for TWCV as a predictor of this outcome.ResultsA total of 878 patients were included in the study with a median follow-up of 1263 days. TWCV above 25% was significantly associated with reduced graft survival (HR3.66, 95% CI 2.3-5.8, p<0.001). Of the 480 patients (54.7%) who had a cumulative TWCV of >25% at a certain time during the follow-up, 110 (22.9%) later returned to a cumulative TWCV of less than 25%. Reduction of TWCV to values below 25% was associated with a hazard of graft loss that was not different from patients who had cumulative TWCV of less than 25% during the entire follow-up period (HR 1.81, 95% CI 0.71-4.62, p=0.218 and HR 1.08, 95% CI 0.39-2.99, p=0.780) in univariate and multivariate analyses, respectively.ConclusionsMonitoring TWCV can help detect the high-risk patients. Interventions intended to reduce variability on long-term graft survival may have a positive effect on graft survival.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据