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Abstract
Background
Calcineurin inhibitor-induced nephrotoxicity is the main cause of renal dysfunction after liver transplantation (LT). The aims of this study were to investigate the changes in kidney function after LT and to determine the optimal tacrolimus level in order to minimize nephrotoxicity at various time points after LT.
Methods
We enrolled 37 LT recipients with a preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and all received immunosuppression including tacrolimus. Renal function was assessed by eGFR. eGFR and tacrolimus level were estimated at 2 weeks, 1, 3, 6, and 12 months after LT. Multivariate regression analysis was applied for determination of mean tacrolimus level minimizing the decrease in eGFR at those time periods. Age, sex, presence of diabetes or hypertension, and use of Simulect were the covariates.
Results
Mean eGFR showed a decrease from 88 to 58 mL/min/1.73 m2 by 3 months after LT. Thereafter, eGFR remained stationary until 1 year. By multivariate regression analysis, mean tacrolimus level minimizing the decrease in eGFR could be obtained. Decrease of eGFR was lower in 12 patients with a mean tacrolimus level below 7.96 ng/mL compared to 25 patients with a mean tacrolimus level above 7.96 ng/mL (0.29 mL/min/1.73 m2 vs. 23.38 mL/min/1.73 m2; P=0.008).
References
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Fig. 1.
Temporal changes of estimated glomerular filtration rate (eGFR) after liver transplantation.
Fig. 2.
Cumulative tacrolimus level (mean) differentiation ΔeGFR most significantly P-value were calculated using multiple regression model controlling age and sex as covariates. Abbreviations: eGFR, estimated glomerular filtration rate; FK, FK506 (Tacrolimus).
Table 1.
Incidence of acute rejection and infection within post-transplant 1 month by blood trough level of tacrolimus
| Tacrolimus a | P-value | ||
|---|---|---|---|
| Low level (n=12) | High level (n=25) | ||
| Acute rejection | 1 (2) | 6 (16) | 0.399 |
| Infection | 0 | 4 (10) | 0.290 |
| Data are presented as number (%). | |||
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