Evaluating the conversion to extended-release tacrolimus from immediate-release tacrolimus in liver transplant...

A new formulation of once daily extended-release tacrolimus (LCP-tac, Envarsus XR) was approved for use in the USA for kidney transplant recipients in 2015. There are limited data regarding real-world observations with conversion to LCP-tac in liver transplant recipients.

We performed a retrospective analysis of liver transplant recipients treated with LCP-tac. Data collection included (1) reasons for switching to LCP-tac; (2) conversion ratio used; (3) kidney function at time of conversion and 3 months after; (4) outcomes of conversion [acute cellular rejection rates and cytomegalovirus (CMV) viremia] within 3 months of conversion.

Average conversion ratio used to achieve therapeutic drug level without further dose adjustment was 1:0.73 (SD 0.11). Median time after transplant was 508 days (IQR 736). Common reasons patients were switched to LCP-tac were from fluctuations in tacrolimus levels (44%) and adverse effect of tremor (32%). Among patients who were switched due to tremors 88% noted significant improvement. There was no difference in serum creatinine (P = 0.55) or glomerular filtration rate (P = 0.64) from baseline to 3 months postconversion. There were no episodes of acute cellular rejections or CMV viremia postconversion.

This observational study demonstrated that conversion of immediate-release tacrolimus to LCP-tac in liver transplant recipients was well tolerated and effective.