Modified Release Tacrolimus in De Novo Immunosuppression After Simultaneous Pancreas–Kidney Transplantation—A First Single-Center Experience

• Published in: Transplantation proceedings 2009-07, Vol.41 (6), p.2573-2575
• Main Authors: Schenker, P, Klein, T, Krüger, B, Claas, S, Wunsch, A, Traska, T, Krämer, B.K, Viebahn, R
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Diabetes Mellitus - surgery; Diabetic Nephropathies - surgery; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Survival - immunology; Histocompatibility Testing; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - immunology; Kidney Transplantation - mortality; Male; Medical sciences; Middle Aged; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Pancreas Transplantation - immunology; Pancreas Transplantation - mortality; Peritoneal Dialysis; Pharmacology. Drug treatments; Prospective Studies; Renal Dialysis; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - therapeutic use; Time Factors; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.06.114

Abstract Background Modified release tacrolimus is a new, once-daily oral formulation of the established immunosuppressive agent tacrolimus. Little is known about de novo immunosuppression after simultaneous pancreas-kidney transplantation using modified release tacrolimus. Methods To test the feasibility of modified release tacrolimus in simultaneous pancreas-kidney transplantation (SPK), we conducted a prospective study of 14 consecutive transplants using modified release tacrolimus (Advagraf, ADV), mycophenolate mofetil, and low-dose corticosteroids as the initial immunosuppressive regimen. Patient and graft survival, the rates of acute rejection, graft function as well as ADV dosages, and trough levels ( Cmin ) were investigated after a mean follow-up time of 11.0 ± 3.1 months. Results Overall patient, kidney, and pancreas graft survival were 100%, 100%, and 93%, respectively. One pancreas graft was lost owing to vascular graft thrombosis 2 days after transplantation. The incidence of rejection episodes at 11 months was 38%. ADV was well tolerated in the majority of patients. Only in 1 case tacrolimus (ADV) was stopped because of psychotic symptoms. In week 2 and 3 posttransplant, a significant adjustment in the ADV dosage was necessary to achieve sufficient tacrolimus trough levels. Conclusions The results of this case series report demonstrate that patients after SPK can be safely treated with modified release tacrolimus. Further studies are needed to investigate pharmacokinetic profiles of modified release tacrolimus after SPK.