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Baker WL, Steiger S, Martin S, Patel N, Radojevic J, Darsaklis K, O'Bara L, Kutzler H, Dougherty J, Feingold A, Hammond J, Fusco D, Gluck JA. Association Between Time-in-Therapeutic Tacrolimus Range and Early Rejection After Heart Transplant. Pharmacotherapy 2019; 39:609-613. [PMID: 30892740 DOI: 10.1002/phar.2262] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Historically, there is perceived pressure to achieve therapeutic levels of tacrolimus quickly after heart transplant (HT). We evaluated the association between time within therapeutic tacrolimus range and time to therapeutic trough and rejection in the 30 days following HT. METHODS This is a single-center retrospective cohort study of consecutive adult HT patients receiving immunosuppression. Goal trough tacrolimus levels were 10-15 ng/ml. Surveillance endomyocardial biopsies were performed weekly for 4 weeks. Outcomes included the effect of time to and time-in-therapeutic tacrolimus range (Rosendaal method) on 30-day clinical rejection, 1R/1B, and 2R or higher histologic occurrences. RESULTS We reviewed 67 HT patients (median age 58.8 yrs). For clinical rejection versus no-rejection groups, the median (25th, 75th percentile) time to therapeutic tacrolimus levels was 9.5 (8, 12.3) days versus 9.0 (7, 13) days (p=0.623). The median time-in-therapeutic tacrolimus range was 34.1% (23.2, 42.2) versus 36.2% (19.9, 51.2), respectively (p=0.512). Similarly, we observed no significant differences in time to and time-in-therapeutic tacrolimus range in patients who developed grade 1R/1B (p=0.650 and p=0.725) or grade 2R or higher histology (p=0.632 and p=0.933). CONCLUSIONS Our small single-center analysis suggests that neither time to nor time in therapeutic tacrolimus range predicted acute rejection within 30 days of HT.
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Affiliation(s)
- William L Baker
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut.,Department of Pharmacy, Hartford Hospital, Hartford, Connecticut
| | - Samantha Steiger
- Department of Pharmacy, Hartford Hospital, Hartford, Connecticut
| | - Spencer Martin
- Department of Pharmacy, Hartford Hospital, Hartford, Connecticut
| | - Nirav Patel
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Heart and Vascular Institute, Hartford HealthCare, Hartford, Connecticut
| | - Joseph Radojevic
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Heart and Vascular Institute, Hartford HealthCare, Hartford, Connecticut
| | - Konstadina Darsaklis
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Heart and Vascular Institute, Hartford HealthCare, Hartford, Connecticut
| | - Lynn O'Bara
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Heather Kutzler
- Department of Pharmacy, Hartford Hospital, Hartford, Connecticut
| | - James Dougherty
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Heart and Vascular Institute, Hartford HealthCare, Hartford, Connecticut
| | - Andrew Feingold
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Heart and Vascular Institute, Hartford HealthCare, Hartford, Connecticut
| | - Jonathan Hammond
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Heart and Vascular Institute, Hartford HealthCare, Hartford, Connecticut
| | - Daniel Fusco
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Heart and Vascular Institute, Hartford HealthCare, Hartford, Connecticut
| | - Jason A Gluck
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut.,Heart and Vascular Institute, Hartford HealthCare, Hartford, Connecticut
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