Successful conversion from twice-daily to once-daily tacrolimus in liver transplantation: observational multicenter study

Abstract

Compliance with immunosuppressive therapy in liver transplant patients is critical to prevent acute organ rejection and/or late graft loss. Strategies to simplify the therapeutic regimen may improve adherence. To evaluate the safety and efficacy of conversion from a twice-daily to once-daily tacrolimus formulation in adult liver transplant patients. This prospective observational multicenter study included 187 liver transplant patients with at least 10 months post-transplant follow-up, no rejection episodes in the last three months, and creatinine levels <2 mg/dL. Conversion from a twice-daily to a once-daily formulation was based on a 1:1 proportion. Median age was 61 yr (range: 28-80 yr); 64% were men and 36% women. The main indications for liver transplant were alcoholic cirrhosis in 30%. Median conversion time was 55 months (range: 10-215 months). Serum tacrolimus levels decreased at one month after conversion (pre-conversion levels = 5.4 ± 3.0 ng/mL vs. post-conversion levels = 4.4 ± 2.4 ng/mL, p = 0.013); however, these values normalized at six months post-conversion with no changes in liver function and rejection episodes were observed only in two patients. Conversion from a twice-daily to a once-daily tacrolimus formulation is a safe, effective strategy in the management of stable liver transplant patients.