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Outcomes of allogeneic ocular surface stem cell transplantation.

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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
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Tacrolimus-Related Kidney Function Change in Ocular Stem Cell Transplantation.

Cameron B Reinisch1, David M Warner2, Albert Y Cheung3,4

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Maintaining therapeutic tacrolimus blood levels after ocular stem cell transplantation showed minimal impact on kidney function. This immunosuppression strategy supports high graft survival rates with acceptable renal outcomes.

Keywords:
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Area of Science:

  • Ophthalmology
  • Nephrology
  • Immunology

Background:

  • Ocular surface stem cell transplantation requires systemic immunosuppression.
  • Tacrolimus is a common immunosuppressant, but its impact on kidney function needs evaluation.
  • Maintaining therapeutic drug levels is crucial for efficacy and safety.

Purpose of the Study:

  • To assess the effect of targeted tacrolimus trough blood levels on kidney function in patients post-ocular surface stem cell transplantation.
  • To evaluate short-term and long-term renal outcomes, including acute kidney injury and chronic kidney disease.
  • To determine the safety profile of tacrolimus in this patient population.

Main Methods:

  • Retrospective chart review of 56 patients from January 2013 to December 2020.
  • Primary outcome: acute kidney injury. Secondary outcomes: serum creatinine, glomerular filtration rate, and chronic kidney disease incidence.
  • Tacrolimus trough levels were monitored, with dose adjustments made to maintain therapeutic ranges.

Main Results:

  • Mean follow-up of 3.07 years.
  • Serum creatinine transiently increased at 1-6 months, returning to baseline by 12 months.
  • 5.4% experienced stage 1 acute kidney injury; 2 patients developed stage 3 chronic kidney disease. 85% required dose adjustments.

Conclusions:

  • Systemic immunosuppression with tacrolimus is well-tolerated after ocular surface stem cell transplantation.
  • Tacrolimus contributes to high graft survival rates.
  • Minimal impact on acute and long-term kidney function was observed.