Low early posttransplant serum tacrolimus levels are associated with poor patient survival in lung transplant patients

Jung-Hwa Ryu; Sunmi Choi; Hyun Joo Lee; Young Tae Kim; Young Whan Kim; Jaeseok Yang

doi:10.4103/atm.ATM_160_18

Official publication of the Saudi Thoracic Society, affiliated to King Saud University

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ORIGINAL ARTICLE

Year : 2019 | Volume : 14 | Issue : 3 | Page : 186-191

Low early posttransplant serum tacrolimus levels are associated with poor patient survival in lung transplant patients

Jung-Hwa Ryu¹, Sunmi Choi², Hyun Joo Lee³, Young Tae Kim³, Young Whan Kim², Jaeseok Yang⁴
¹ Transplant Center, Seoul National University Hospital, Seoul, Republic of Korea
² Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
³ Department of Thoracic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
⁴ Transplant Center; Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea

Correspondence Address:
Dr. Jaeseok Yang
Transplantation Center, Department of Surgery, Seoul National University Hospital, Transplantation Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Chongno-gu, Seoul
Republic of Korea

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/atm.ATM_160_18

BACKGROUND: Low-dose tacrolimus-based immunosuppression is a standard therapy in kidney and liver transplantation; however, the optimal therapeutic level of tacrolimus has not been established in lung transplantation. We aimed to identify the tacrolimus level associated with better outcomes in lung transplant patients. METHODS: This retrospective study included patients who underwent lung transplantation at Seoul National University Hospital between 2006 and 2016. Kaplan–Meier survival analysis and Cox regression were performed according to tacrolimus levels at several time-points within 1-year posttransplantation. RESULTS: A total of 43 patients received bilateral lung transplantation. The median age was 53 years and the median follow-up was 20.5 months. Overall and 1-year patient survival rates were 55.8% and 74.4%, respectively. Infection was the most common cause of death (78.9%). Chronic lung allograft dysfunction was observed in 16.3%. A tacrolimus level <9 ng/ml at 1 month was associated with lower rejection-free survival (P = 0.009). A time-averaged tacrolimus level <10 ng/ml within 1 month posttransplantation was an independent risk factor for poor patient survival (hazard ratio: 4.904; 95% confidence interval: 1.930–12.459; P= 0.001). Furthermore, higher tacrolimus levels did not increase infectious complications. CONCLUSIONS: These finding suggest that tacrolimus levels ≥10 ng/ml within 1 month after lung transplantation appear to be associated with better patient survival.

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