Tacrolimus dose requirements in African-American and Caucasian kidney transplant recipients on mycophenolate and prednisone

• Published in: Clinical transplantation 2014-07, Vol.28 (7), p.762-767
• Main Authors: Beermann, Kristi J., Ellis, Matthew J., Sudan, Debra L., Harris, Matthew T.
• Format: Article
• Language: English
• Subjects: African American; African Americans - statistics & numerical data; Anti-Inflammatory Agents - therapeutic use; Caucasian; dose requirements; Dose-Response Relationship, Drug; Drug Therapy, Combination; European Continental Ancestry Group - statistics & numerical data; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection - drug therapy; Graft Rejection - etiology; Graft Survival - drug effects; Humans; Immunosuppressive Agents - therapeutic use; kidney; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - surgery; Kidney Function Tests; Kidney Transplantation - adverse effects; Male; Middle Aged; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Prednisone - therapeutic use; Prognosis; Retrospective Studies; Risk Factors; tacrolimus; Tacrolimus - administration & dosage; transplant; Transplant Recipients
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12376

Racial differences among kidney transplant recipients may impact the total daily tacrolimus dose required to achieve therapeutic tacrolimus concentrations. Previous studies suggest that African Americans require higher doses to achieve similar therapeutic drug concentrations compared with Caucasians. Data were collected on a total of 147 de novo kidney transplant recipients. Tacrolimus total daily dose (TDD) requirements (mg/kg/d) and tacrolimus concentrations were retrospectively reviewed at discharge and at days 30, 60, and 90 after transplant. TDD requirements in African‐American and Caucasian patients were 0.14 mg/kg/d and 0.11 mg/kg/d, respectively (p = 0.005), at day 30. TDD requirements at day of hospital discharge and days 60 and 90 following transplant were significantly higher in African‐American patients vs. Caucasian patients, with similar tacrolimus concentrations at all time points. This study suggests that when compared to Caucasians, African Americans require significantly higher TDD of tacrolimus to achieve similar tacrolimus concentrations. These findings provide transplant clinicians with a sense of certainty to more rapidly titrate daily tacrolimus doses in African‐American patients to achieve therapeutic concentrations.