Can initial tacrolimus trough levels be predicted from clinical variables?

• Published in: Transplantation proceedings Vol. 36; no. 9; pp. 2816 - 2818
• Main Authors: Baran, D.A., Galin, I.D., Zucker, M.J., Alvi, S., Arroyo, L.H., Lubitz, S., Kaplan, S., Correa, R., Courtney, M.C., Chan, M., Spielvogel, D., Lansman, S.L., Gass, A.L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2004; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Creatinine - blood; Echocardiography; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Heart Transplantation - immunology; Hematocrit; Humans; Immunosuppressive Agents - blood; Immunosuppressive Agents - pharmacokinetics; Male; Medical sciences; Middle Aged; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - blood; Tacrolimus - pharmacokinetics; Tissue, organ and graft immunology; Treatment Outcome; Calcineurin inhibitor; Prediction; Lactone; Transplantation; Macrolide; Medicine; Treatment; Surveillance; Tacrolimus; Surgery; Clinical biology; Graft; Clinical investigation; Immunosuppressive agent; Predictive factor
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2004.09.037

In eligible patients, cardiac transplantation has become the definitive treatment for end-stage heart failure. The initial posttransplantation course is marked by many potential difficulties, including renal insufficiency, hemodynamic instability, and perioperative bleeding. It is important to prevent early rejection; calcineurin inhibitors, such as tacrolimus or cyclosporine, are integral parts of such management. However, these drugs are associated with renal toxicity in some patients. Previous work suggests that limiting the increase in tacrolimus levels is associated with less renal insufficiency. The hypothesis of the current study was that a combination of clinical or laboratory variables could identify patients at risk for rapid changes in tacrolimus target levels. No single variable was strongly associated with high resultant trough levels following a standard 1-mg oral “test dose” of tacrolimus. However, the combination of 2 indices of liver metabolism (alanine aminotransferase and total bilirubin) along with serum creatinine did identify patients who tended toward elevated levels of tacrolimus (≥4.5 ng/dL). Other variables, such as demographics, and even functional variables, such as right ventricular function by echocardiography, did not enhance the predictive value of this simple scoring system.