Correlation of Tough Tacrolimus Level with Early Acute Rejections in Renal Allograft Recipients- A Prospective Study
Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2018, Vol 1, Issue 3
Abstract
Acute Rejection is the key mediators of long term graft loss. So we aimed the present study to assess the correlation of baseline pre transplant trough tacrolimus level with early rejection. We prospectively analyzed the trough tacrolimus level on the day prior to transplantation of 179 patients transplanted from September 2007 to September 2009. We divided them into three groups according to the trough levels: Group I = < 5 ng/ml, Group II = 5-15 ng/ml and Group III = > 15ng/ml. Their demography, incidence of BPAR, NOD, infections and biopsy proven CNI toxicity were studied. Incidence of BPAR were the highest in the Group I and lowest in the Group III. None of the patients in Group III had rejection with Banff grade > 2. Incidences of post transplant at infection, new onset diabetes were comparable. Trend towards higher incidence of biopsy proven CNI toxicity was noted from Group I to Group III. These results indicate that the incidence as well as severity of early rejection reduces as the pre transplant trough tacrolimus level increases. Trend towards higher nephrotoxicity with higher trough level was noted [1-25]. Short-term transplant outcomes have improved such that, if no rejection episodes occur, recipients of live donor grafts can now expect graft function to exceed 95% at 1 year and 90% after 5 years. Several studies have shown that acute rejection is the most significant risk factor for chronic rejection and potential surrogate for long-term graft failure. Several trials are now aimed at the reduction of early acute rejection episodes to improve long term graft survival [1-24]. Transplantation with living donor allows anticipated planning of the procedure, which can be performed before dialysis treatment, and prior administration of an immunosuppressant scheme. Pre-transplant administration of immunosuppressant aims to minimize the incidence and severity of episodes of acute rejection. The risk of acute rejection is greater in the first week post-transplant and progressively decreases after the first months. Thus, the concentration of immunosuppressive drugs must be maximal at this initial phase and tapered during subsequent months, according to the evolution of patient and graft function [25-60]. Many transplantation centers advocate the administration of immunosuppressant pre-transplant, with a variation of one to five pre-operative days, while other centers only start the therapy after the surgery. The potential disadvantages of early administration of immunosuppressant therapy are the risk of infection and the nephrotoxicity effects of calcineurin inhibitors during allograft reperfusion. Up to the present moment, there is only one systematic study that addresses the impact of pre-transplant administration of immunosuppressive therapy consisting of cyclosporine as the CNI, on incidence and severity of acute rejection [60-75].
Authors and Affiliations
Manish Tripathi, Kalpesh Gohel, Umapati Hegde, Sishir Gang, Mohan Rajapurkar
Keywords
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- EP ID EP569140
- DOI 10.32474/IGWHC.2018.01.000111
- Views 94
- Downloads 0
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