#4991 IMMUNE MODULATING DRUGS AND ORAL ANTICOAGULATION IN KIDNEY TRANSPLANT: COMPARISON OF DIRECT ORAL ANTICOAGULANTS VERSUS ANTAGONIST OF VITAMIN-K

Abstract

Abstract Background and Aims Direct oral anticoagulants (DOACs) are a well-known alternative to conventional antagonist of vitamin-K (avK) and have emerged as the preferred choice due to their safety and efficacy profile. However, immune modulating drugs as cyclosporine and tacrolimus, commonly used for transplant recipients, may interfere with DOACs pharmacokinetic. Our study evaluates safety and efficacy profile of direct oral anticoagulants (DOACs) compared to avK in kidney transplant recipients (KTRs) treated with immune modulating agents. Methods A multi-center retrospective observational study from 4 Italian hospitals enrolling KTRs on DOACs or avK was carried out. Sixty-six patients on DOACs were compared with fifty patients on avK with similar clinical features. Serial evaluation of renal function and serum levels of immune modulating drugs during 24 months follow-up (FU) was performed. Results Mean age of DOACs patients was 67±9 and mean eGFR was 58,3± 30,4mL/min/1.73 m2. Immune-modulating therapy included tacrolimus (n = 47, 71%), cyclosporin (n = 13, 20%), everolimus (n = 10, 7%) and sirolimus (n = 4, 6%). After 14 days of DOACs therapy initiation there was a slight increase of serum levels of tacrolimus (+0.19±0.67 p = 0.80) and cyclosporine (+0.12±0.25 p = 0.94) not statistically significant. Only a patient treated with dabigatran 150 mg required a dose adjustment. Levels of tacrolimus and cyclosporin were stable at serial evaluation during 18-months follow-up. There were no thromboembolic events among patients treated with DOACs or avK and no differences in term of mayor bleeding (5.8% vs 4% p = 0.99), at long-term follow-up. There was no difference in term of eGFR decline from start therapy to 18 months FU between DOACs or avK therapy (-3.9±1 vs −3.8±2 p = 0.82). Conclusion DOACs are a potential therapeutic option among kidney transplant recipients treated with immune modulating drugs. Careful evaluation of immunomodulating agent levels during the first two week of therapy should be recommended. No difference in term of bleeding, thromboembolic events and renal function decline was found when comparing with avK therapy.