대한신장학회

논문분류	춘계학술대회 초록집
제목	Comparison of transplant outcomes for low-dose and standard-dose tacrolimus in kidney transplants
저자	Kyu Yeun Kim* 1, Sun-Young Cho1, Su Kyung Lee 1, Minjung Kim1, Wonseok Do1, Youngae Yang1, Taehoon Yim1, Inryang Hwang1, Hee-Yeon Jung1, Ji-Young Choi1, Jang-Hee Cho1, Sun-Hee Park1, Yong-Lim Kim1, Hyung-Kee Kim2, Seung Huh2, Dong-Il Won3, Chan-Duck Kim1
출판정보	2016; 2016(1):
키워드	BPAR, Kidney transplantation, tacrolimus, TDM
초록	Background: There are few studies that compare the effect of different dose of tacrolimus after kidney transplantation. We investigated transplant outcome of low-dose and standard-dose tacrolimus in the post-transplant period. Methods: This study included 278 patients who underwent kidney transplantation between 2010 and 2014. All the patients received tacrolimus, mycophenolic acid, and steroid. Patients were divided into low-dose and standard-dose tacrolimus group (4-7 and 7-12 ng/ml for 0-2 months, 3-6 and 6-10 ng/ml for 3-6 months, 2-5 and 5-8 ng/ml for 7-12 months, respectively) by tacrolimus trough level at each period. We compared estimated glomerular filtration rate (eGFR), biopsy-proven acute rejection (BPAR), opportunistic infection and graft survival. Results: There was no difference in baseline characteristics between two groups, except higher percentage of delayed graft function in low-dose group than standard-dose group in 0-2 months (10.1 vs 3.1%, P=0.03). Standard-dose group showed higher mean eGFR than low-dose group for 0-2 months (69.9 ± 17.2 vs 63.8 ± 19.2 ml/min/1.73m2, p=0.006), while eGFR was not different by tacrolimus dose thereafter. Patients with persistently standard-dose tacrolimus for 12-months revealed significantly higher eGFR than those with persistently low-dose tacrolimus (65.9 ± 14.3 vs 58.2 ± 19.0 ml/min/1.73m2, p=0.025). Incidence of BPAR was not different until 6 months, however, BPAR was significantly higher in low-dose group than standard dose group (3.9 vs 0.0%, P=0.039) for 7-12 months. Multivariate analysis showed that tacrolimus concentration was an independent risk factor for BPAR (odds ratio=0.31, 95% confidence interval=0.10-0.93, P=0.037). During mean follow-up of 31.9 ± 16.7 months, no significant differences of serious infections and graft survival were observed. Conclusion: Standard-dose tacrolimus was associated with better graft function after kidney transplantation. Maintenance of proper tacrolimus level after 6 months could reduce acute rejection. However, dosing of tacrolimus did not have significant effect on graft survival in kidney transplants with tacrolimus-based triple therapy regimen.
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