Conversion From Twice-Daily to Once-Daily Tacrolimus Among Egyptian Living-Donor Kidney Allograft Recipients: A Single-Center Experience

• Published in: Experimental and clinical transplantation Vol. 17; no. 5; pp. 594 - 598
• Main Authors: Bakr, Mohamed Adel, Nagib, Ayman Maher, Abbas, Mohamed Hamed, Donia, Ahmed Farouk
• Format: Journal Article
• Language: English
• Published: Başkent Üniversitesi 01-10-2019
• Subjects: Tıp; Ankara; Türkiye; Adherence; Advagraf; Immunosuppression; Renal transplant
• ISSN: 1304-0855; 2146-8427
• DOI: 10.6002/ect.2018.0147

Objectives: Adherence to immunosuppression and
minimization of drug exposure are important con -
siderations in preventing rejection and maximizing
transplant outcomes. The once-daily tacrolimus
protocol confers potential benefit by simplifying
immunosuppressive regimens, thereby improving
adherence among transplant recipients. Studies of
stable transplant recipients have suggested that oncedaily
tacrolimus is bioequivalent to twice-daily
tacrolimus and is noninferior to twice-daily tacrolimus
with a concentration-dependent rejection risk. Our
aim was to evaluate the safety and efficacy of
conversion from twice-daily tacrolimus formulation to
a once-daily formulation among a cohort of adult
living related-donor renal transplant patients as a
single-center experience.
Materials and Methods: This prospective, one arm,
single-center study included 238 patients with at least
12 months posttransplant follow-up and no rejection
episodes in the last 3 months. Conversion from twicedaily
to once-daily formulation was based on a 1:1
ratio.
Results: The mean tacrolimus dose was 4.7 ± 2.7 mg/day
preconversion versus 4.9 ± 3.2 mg/day postconversion
(P = .8). The mean tacrolimus level was 7.4 ± 3.4 versus
6.1 ± 2.8 ng/mL (P = .75). Of total patients, 45% were
maintained on a tacrolimus dose of less than 2 ng/dL.
Renal function was comparable before and after
conversion (mean serum creatinine was 1.25 ± 0.88 vs
1.23 ± 0.78 mg/dL; P = .9). The incidence of biopsyproven
acute rejection was 19.7% preconversion
versus 4.2% postconversion. Graft and patient survival
rates were comparable between the 2 tacrolimus formulations. Once-daily tacrolimus also had favorable
effects on blood pressure, lipid profile, and glucose
tolerance.
Conclusions: Conversion from conventional tacrolimus
(twice daily) to once-daily tacrolimus may be a
valuable option with comparable patient and graft
survival and may lead to improved adherence that
may be reflective of better long-term results. It should
be considered for de novo immunosuppression
among living-donor renal allotransplant recipients.