Successful conversion from twice-daily to once-daily tacrolimus in liver transplantation: Observational multicenter study

摘要

Background: Compliance with immunosuppressive therapy in liver transplant patients is critical to prevent acute organ rejection and/or late graft loss. Strategies to simplify the therapeutic regimen may improve adherence. Aim: To evaluate the safety and efficacy of conversion from a twice-daily to once-daily tacrolimus formulation in adult liver transplant patients. Patients and methods: This prospective observational multicenter study included 187 liver transplant patients with at least 10months post-transplant follow-up, no rejection episodes in the last threemonths, and creatinine levels <2mg/dL. Conversion from a twice-daily to a once-daily formulation was based on a 1:1 proportion. Results: Median age was 61yr (range: 28-80yr); 64% were men and 36% women. The main indications for liver transplant were alcoholic cirrhosis in 30%. Median conversion time was 55months (range: 10-215 months). Serum tacrolimus levels decreased at onemonth after conversion (pre-conversion levels=5.4±3.0ng/mL vs. post-conversion levels= 4.4± 2.4ng/mL, p=0.013); however, these values normalized at sixmonths post-conversion with no changes in liver function and rejection episodes were observed only in two patients. Conclusion: Conversion from a twice-daily to a once-daily tacrolimus formulation is a safe, effective strategy in the management of stable liver transplant patients.