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- Title
Erişkin Böbrek Nakli Hastalarında Uzun Etkili Takrolimus Kullanımı, Uzun Dönem Böbrek ve Hasta Sağkalımı Üzerine Etkisi, Tek Merkez Deneyimi.
- Authors
Alpay, Nadir; Yıldız, Alaattin
- Abstract
Introduction: Tacrolimus is one of the most important immunosuppressive agents used in organ transplant patients. There is information that the long-acting tacrolimus preparation reduces polypharmacy and keeps the tacrolimus blood level more stable. We aimed to investigate the effect on renal function change and patient survival in kidney transplant patients who were switched to long-acting tacrolimus and followed up for at least 1 year in our organ transplant unit. Materials and Methods: In our single-center retrospective observational study, the files of 934 patients who underwent kidney transplantation in our unit were scanned. Forty-five patients who were converted from tacrolimus to extendedrelease tacrolimus after screening or were followed-up for at least 1 year were included in the study. Along with the demographic data of the patients, creatinine at the time of change, follow-up times after the change, last creatinine values and patient survival were evaluated. Delta creatinine level was calculated by subtracting the patient's creatinine level at the moment of change from the patient's last creatinine. Results The mean age of 45 patients included in the study was 47.7 ± 13.6 years (minimum 19 - max 70). Of the patients, 29 (64.4%) were male and 16 (35%) were female. 5 (11.1%) of the patients were over 65 years of age. When primary kidney diseases of the patients were evaluated, 5 (11.1%) diabetic kidney disease, 5 (11.1%) primary glomerulonephritis; 4 (8.9%) were hypertensive nephrosclerosis; 4 of them were autosomac dominant polycystic kidney disease and 5 of them were renal failure due to obstructive nephropathy. 10 (22.2%) were due to other causes and 12 patients (26.7%) had unknown primary kidney disease. 3 (6.7%) of the patients were second transplantation. Before conversion, 39 patients (86%) were using tacrolimus + mycophenolate mofetil/mycophenolate sodium (MPM / MPS) + prednisolone, while 3 patients (6.7%) were using tacrolimus + azathiopurine + perdnisolone. 2 patients (4.4%) were using tacrolimus + everolimus + prednisolone, and 1 patient (2.2%) was using tacrolimus + MPM. Eight of the patients (17.8%) were pretransplanted with long-acting tacrolimus denovo -3. started on the day. In 2 patients (4.4%), conversion to long-acting tacrolimus was performed at posttransplant week 1. Of the remaining 35 patients, 29 were changed to long-acting tacrolimus due to variability in tacrolimus blood levels, 3 patients due to polypharmacy, and 3 patients due to tacrolimus variability in the duration of viral infection. The mean creatinine at the time of change was 1.23 ± 0.34 mg/dl (min 0.60, max 1.90). The median time to change was 39 (IQR 22-77, min 3 months, max 190 months). The mean follow-up period of the patients after the change was 44.8 ±14.6 months (min 14, max 74 months). The mean creatinine mean of the patients at the last follow-up was 1.48 ± 0.49 mg/dl (min was 0.7, max was 3.7). The median delta creatinine of the patients was 0.10 (IQR was -0.05 - 0.40 mg/dl). In 2 of the patients (4.4%), DSA (Donor-specific antibody) developed during the follow-up and antibody-mediated rejection developed. While 5 (11.1%) of the 45 patients who were followedup died, the follow-up of 40 patients is still continuing in our unit. Of the patients wiThex, 3 (60%) were over 65 years old and 2 were under 65 years old. Elderly patients had a higher mortality rate (p <0.001). Conclusion: The most important reason for conversion to extended release tacrolimus in our unit was tacrolimus blood level variability. There was no significant change in the creatinine levels of the patients who were followed up for an average of 4 years after the change. Post-conversion mortality was higher especially in patients over 65 years of age. The use of long-acting tacrolimus did not cause a significant change in creatinine levels.
- Publication
Sakarya Tıp Dergisi, 2023, Vol 13, Issue 2, p240
- ISSN
2146-2585
- Publication type
Article
- DOI
10.31832/smj.1255312