Tacrolimus therapeutic drug monitoring and pediatric renal transplant graft outcomes

N. Larkins, D. G. Matsell

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Predose monitoring of tacrolimus levels is standard practice in the care of pediatric renal transplant patients. This is despite a paucity of data investigating the ideal target range in children, and controversy as to whether tacrolimus levels correlate with renal transplant outcomes. We performed a retrospective cohort analysis of 48 renal transplant patients at a single Canadian pediatric transplant center following the initiation of a tacrolimus-mycophenolate-prednisone-based IS protocol. We analyzed the relationship of graft function, as defined by GFR up to five yr post-transplant, to the preceding mean tacrolimus level. There was no significant correlation between absolute GFR and mean tacrolimus levels (r = 0.206, p = 0.38). However, a higher mean tacrolimus level, particularly ≥10 ng/mL in the first three months after transplantation, was associated with a slower rate of decline in GFR with time (r = 0.608, p = 0.004) and with a less likelihood of developing CKD five yr after transplant. We suggest that the optimal target range for tacrolimus levels may be at the upper end of what is currently practiced and that further research to validate these findings would be useful.
Original languageEnglish
Pages (from-to)803-9
Number of pages7
JournalPediatric Transplantation
Volume18
Issue number8
DOIs
Publication statusPublished - Dec 2014
Externally publishedYes

Fingerprint

Drug Monitoring
Tacrolimus
Pediatrics
Transplants
Kidney
Prednisone
Cohort Studies
Transplantation
Research

Cite this

@article{28813d4a88a544a0b8b328f4efd9e7ac,
title = "Tacrolimus therapeutic drug monitoring and pediatric renal transplant graft outcomes",
abstract = "Predose monitoring of tacrolimus levels is standard practice in the care of pediatric renal transplant patients. This is despite a paucity of data investigating the ideal target range in children, and controversy as to whether tacrolimus levels correlate with renal transplant outcomes. We performed a retrospective cohort analysis of 48 renal transplant patients at a single Canadian pediatric transplant center following the initiation of a tacrolimus-mycophenolate-prednisone-based IS protocol. We analyzed the relationship of graft function, as defined by GFR up to five yr post-transplant, to the preceding mean tacrolimus level. There was no significant correlation between absolute GFR and mean tacrolimus levels (r = 0.206, p = 0.38). However, a higher mean tacrolimus level, particularly ≥10 ng/mL in the first three months after transplantation, was associated with a slower rate of decline in GFR with time (r = 0.608, p = 0.004) and with a less likelihood of developing CKD five yr after transplant. We suggest that the optimal target range for tacrolimus levels may be at the upper end of what is currently practiced and that further research to validate these findings would be useful.",
author = "N. Larkins and Matsell, {D. G.}",
year = "2014",
month = "12",
doi = "10.1111/petr.12369",
language = "English",
volume = "18",
pages = "803--9",
journal = "Pediatric Transplantation",
issn = "1397-3142",
publisher = "John Wiley & Sons",
number = "8",

}

Tacrolimus therapeutic drug monitoring and pediatric renal transplant graft outcomes. / Larkins, N.; Matsell, D. G.

In: Pediatric Transplantation, Vol. 18, No. 8, 12.2014, p. 803-9.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Tacrolimus therapeutic drug monitoring and pediatric renal transplant graft outcomes

AU - Larkins, N.

AU - Matsell, D. G.

PY - 2014/12

Y1 - 2014/12

N2 - Predose monitoring of tacrolimus levels is standard practice in the care of pediatric renal transplant patients. This is despite a paucity of data investigating the ideal target range in children, and controversy as to whether tacrolimus levels correlate with renal transplant outcomes. We performed a retrospective cohort analysis of 48 renal transplant patients at a single Canadian pediatric transplant center following the initiation of a tacrolimus-mycophenolate-prednisone-based IS protocol. We analyzed the relationship of graft function, as defined by GFR up to five yr post-transplant, to the preceding mean tacrolimus level. There was no significant correlation between absolute GFR and mean tacrolimus levels (r = 0.206, p = 0.38). However, a higher mean tacrolimus level, particularly ≥10 ng/mL in the first three months after transplantation, was associated with a slower rate of decline in GFR with time (r = 0.608, p = 0.004) and with a less likelihood of developing CKD five yr after transplant. We suggest that the optimal target range for tacrolimus levels may be at the upper end of what is currently practiced and that further research to validate these findings would be useful.

AB - Predose monitoring of tacrolimus levels is standard practice in the care of pediatric renal transplant patients. This is despite a paucity of data investigating the ideal target range in children, and controversy as to whether tacrolimus levels correlate with renal transplant outcomes. We performed a retrospective cohort analysis of 48 renal transplant patients at a single Canadian pediatric transplant center following the initiation of a tacrolimus-mycophenolate-prednisone-based IS protocol. We analyzed the relationship of graft function, as defined by GFR up to five yr post-transplant, to the preceding mean tacrolimus level. There was no significant correlation between absolute GFR and mean tacrolimus levels (r = 0.206, p = 0.38). However, a higher mean tacrolimus level, particularly ≥10 ng/mL in the first three months after transplantation, was associated with a slower rate of decline in GFR with time (r = 0.608, p = 0.004) and with a less likelihood of developing CKD five yr after transplant. We suggest that the optimal target range for tacrolimus levels may be at the upper end of what is currently practiced and that further research to validate these findings would be useful.

U2 - 10.1111/petr.12369

DO - 10.1111/petr.12369

M3 - Article

VL - 18

SP - 803

EP - 809

JO - Pediatric Transplantation

JF - Pediatric Transplantation

SN - 1397-3142

IS - 8

ER -