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- W2955886960 abstract "Background: There are inconsistent findings regarding the relationship between trough whole blood tacrolimus concentration (TAC C 0 ) and acute kidney rejection in recipients undergoing TAC therapeutic drug monitoring (TDM). However, studies have not always assessed TAC C 0 at the time of rejection or accounted for variability in hematocrit. Therefore, this study aimed to investigate the temporal relationship between TAC C 0 and acute rejection, including when accounting for variation in hematocrit. Methods: For 38 recipients who developed biopsy-proven acute rejection (BPAR) in the first 14 days after kidney transplantation, daily TAC C 0 from TDM and hematocrit was collected from case notes. Differences in log 10 -transformed TAC C 0 between the day of BPAR (log C r ), 1 day before BPAR (log C r-1 ), and 2 days before BPAR (log C r-2 ) and the combined median concentrations for the days preceding these (log C prior ) were examined by repeated-measures analysis of variance with Dunnett post hoc testing. Generalized linear mixed-effects regression (glmer) examined the ability of TAC C 0 to predict acute rejection episodes with and without controlling for hematocrit. Results: Log C r-1 [mean difference (95% confidence interval) = −0.13 (−0.21 to −0.048), post hoc P = 0.002] and log C r [−0.13 (−0.24 to −0.025), post hoc P = 0.013] were significantly lower than log C prior . TAC C 0 was a significant ( P = 0.0078) predictor of rejection episodes (area under the receiver operating characteristic curve = 0.79) only in glmer models accounting for variability in hematocrit. Conclusions: In recipients who developed BPAR, there was a significant temporal relationship between TAC C 0 and BPAR incidence under TAC TDM that may not be detected in cross-sectional studies, especially if variability in hematocrit is not addressed. This supports a TAC C 0 –rejection relationship, which differs between recipients, and may explain why some recipients do or do not experience rejection within or below the TDM range, respectively. However, studies with larger sample sizes are needed to confirm this finding." @default.
- W2955886960 created "2019-07-12" @default.
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- W2955886960 date "2019-08-01" @default.
- W2955886960 modified "2023-09-28" @default.
- W2955886960 title "Is There a Temporal Relationship Between Trough Whole Blood Tacrolimus Concentration and Acute Rejection in the First 14 Days After Kidney Transplantation?" @default.
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- W2955886960 doi "https://doi.org/10.1097/ftd.0000000000000656" @default.
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