High Tacrolimus Intra-Patient Variability and Adverse Outcomes in Cardiac Transplant Recipients: A Single-Center...

Area of Science:

• Immunology
• Pharmacology
• Transplantation Medicine

Background:

• Tacrolimus is a crucial immunosuppressant in cardiac transplantation.
• Maintaining stable tacrolimus levels is vital for graft survival and preventing adverse events.
• Tacrolimus intra-patient variability (IPV) may impact patient prognosis.

Purpose of the Study:

• To investigate the association between tacrolimus intra-patient variability (IPV) and the prognosis of cardiac transplant recipients.
• To determine if high tacrolimus IPV is linked to increased risks of infection, rejection, or mortality.

Main Methods:

• Tacrolimus trough concentrations (C0) were collected from 202 cardiac transplant recipients between postoperative months 3-6.
• Dose-adjusted IPV was calculated, and patients were categorized into high-IPV and low-IPV groups.
• The composite endpoint included infection, rejection, or mortality.

Main Results:

• The high-IPV group exhibited a significantly higher incidence of infections (34.8% vs. 21.1%).
• High tacrolimus IPV was associated with approximately 2.2 times higher risk of infection and 2.1 times higher risk of the composite endpoint.
• No significant differences in rejection or mortality were found between groups.

Conclusions:

• Elevated tacrolimus IPV in cardiac transplant recipients is associated with an increased risk of adverse events, particularly infections.
• Tacrolimus IPV serves as a practical tool for predicting postoperative complications in these patients.