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Hidaka Y, Goto N, Yamanaga S, Kinoshita K, Tanaka K, Kawabata C, Toyoda M, Tomosugi T, Futamura K, Okada M, Tsujita M, Hiramitsu T, Yokomizo H, Miyata A, Narumi S, Kobayashi T, Watarai Y. Two-Year Outcomes of Low-Exposure Extended-Release Tacrolimus and Mycophenolate Mofetil Regimen in De Novo Kidney Transplantation: A Multi-center Randomized Controlled Trial. Clin Transplant 2022; 36:e14655. [PMID: 35343620 DOI: 10.1111/ctr.14655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Once-daily extended-release tacrolimus (TACER) is commonly administered following kidney transplantation (KTx); however, its optimal dosage remains unknown. METHODS In this multi-center, randomized controlled trial, 62 living donor KTx recipients were assigned to either standard-exposure (SE; n = 32) or low-exposure (LE; n = 30) TACER (Graceptor®, Astellas Pharm Inc.) groups. All patients received basiliximab and mycophenolate mofetil (MMF). The primary outcomes were acute rejection, graft/patient survival, and the secondary outcomes were incidence of cytomegalovirus infection, and de novo donor-specific antibodies (dnDSA) production. RESULTS The tacrolimus trough level and estimated area under the blood concentration-time curve (eAUC) were significantly higher in SE than in LE (SE vs LE; one year: 5.0 ± 0.9 ng/mL and 206.9 ± 26.8 ngཥh/mL vs 3.4 ± 1.0 ng/mL and 153.9 ± 26.4 ngཥh/mL; two years: 4.8 ± 1.0 ng/mL and 204.9 ± 30.1 ngཥh/mL vs 3.8 ± 0.9 ng/mL and 164.4 ± 27.0 ngཥh/mL). In contrast, the dosage and eAUC of MMF did not differ between groups. Two-year graft and patient survival rates were 100% in both groups, and acute rejection rates were 0% and 10% in the SE and LE, respectively (p = 0.11). The mean estimated glomerular filtration rates did not differ between the groups. Cytomegalovirus infection was slightly lower in the LE (SE: 12.5% and LE: 6.7%, p = 0.37). In the LE, four cases of dnDSA were noted within two years of transplantation; no case was observed in the SE (p = 0.034). CONCLUSIONS Although the LE TACER regimen showed similar rates of acute rejection, as well as graft and patient survival compared with SE after KTx, LE was significantly more associated with dnDSA. Further investigation of its long-term effect on graft survival is warranted. (University Hospital Medical Information Network Clinical Trials Registry ID: UMIN000033089). This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuji Hidaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.,Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Aichi, Japan
| | - Norihiko Goto
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shigeyoshi Yamanaga
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kohei Kinoshita
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kosuke Tanaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Chiaki Kawabata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mariko Toyoda
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Toshihide Tomosugi
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Makoto Tsujita
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Akira Miyata
- Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shunji Narumi
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant Nephrology and Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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