Abstract
Renal impairment is a typical side effect of tacrolimus (Tac) treatment in liver transplant (LT) recipients. One strategy to avoid renal dysfunction is to increase the concentration/dose (C/D) ratio by improving drug bioavailability. LT recipients converted from standard-release Tac to MeltDose® Tac (LCPT), a novel technological formulation, were able to reduce the required Tac dose due to higher bioavailability. Hence, we hypothesize that such a conversion increases the C/D ratio, resulting in a preservation of renal function. In the intervention group, patients were switched from standard-release Tac to LCPT. Clinical data were collected for 12 months after conversion. Patients maintained on standard-release Tac were enrolled as a control group. Twelve months after conversion to LCPT, median C/D ratio had increased significantly by 50% (p < 0.001), with the first significant increase seen 3 months after conversion (p = 0.008). In contrast, C/D ratio in the control group was unchanged after 12 months (1.75 vs. 1.76; p = 0.847). Estimated glomerular filtration rate (eGFR) had already significantly deteriorated in the control group at 9 months (65.6 vs. 70.6 mL/min/1.73 m2 at study onset; p = 0.006). Notably, patients converted to LCPT already had significant recovery of mean eGFR 6 months after conversion (67.5 vs. 65.3 mL/min/1.73 m2 at study onset; p = 0.029). In summary, conversion of LT recipients to LCPT increased C/D ratio associated with renal function improvement.
Highlights
The calcineurin inhibitor tacrolimus (Tac) is considered a first-line immunosuppressant in liver transplant (LT) recipients [1,2,3,4]
The present study shows that the conversion of LT recipients from standard-release Tac to LCPT was beneficial in regard to renal function
The median C/D ratio among LT recipients who switched to LCPT had increased by 50% at 12 months after conversion
Summary
The calcineurin inhibitor tacrolimus (Tac) is considered a first-line immunosuppressant in liver transplant (LT) recipients [1,2,3,4]. Several studies have revealed that the risk of CNIT is associated with both high Tac trough concentration and high daily Tac dose [10,11], CNIT may occur even with low-dose regimens [12]. A low IR-Tac C/D ratio is linked with higher C2 Tac blood concentrations despite comparable trough levels in patients with high C/D ratios [16]. In this regard, a low C/D ratio is strongly associated with an increased risk of CNIT and a faster decline of renal function in both kidney transplant (KT) and LT recipients [13,16,17,18,19]. One way of potentially influencing the pharmacokinetics of Tac is to change the formulation of the drug [20]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
