Association Between Time‐in‐Therapeutic Tacrolimus Range and Early Rejection After Heart Transplant
Background Historically, there is perceived pressure to achieve therapeutic levels of tacrolimus quickly after heart transplant (HT). We evaluated the association between time within therapeutic tacrolimus range and time to therapeutic trough and rejection in the 30 days following HT. Methods This i...
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| Veröffentlicht in: | Pharmacotherapy 2019-05, Vol.39 (5), p.609-613 |
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| creator | Baker, William L. Steiger, Samantha Martin, Spencer Patel, Nirav Radojevic, Joseph Darsaklis, Konstadina O'Bara, Lynn Kutzler, Heather Dougherty, James Feingold, Andrew Hammond, Jonathan Fusco, Daniel Gluck, Jason A |
| description | Background
Historically, there is perceived pressure to achieve therapeutic levels of tacrolimus quickly after heart transplant (HT). We evaluated the association between time within therapeutic tacrolimus range and time to therapeutic trough and rejection in the 30 days following HT.
Methods
This is a single‐center retrospective cohort study of consecutive adult HT patients receiving immunosuppression. Goal trough tacrolimus levels were 10–15 ng/ml. Surveillance endomyocardial biopsies were performed weekly for 4 weeks. Outcomes included the effect of time to and time‐in‐therapeutic tacrolimus range (Rosendaal method) on 30‐day clinical rejection, 1R/1B, and 2R or higher histologic occurrences.
Results
We reviewed 67 HT patients (median age 58.8 yrs). For clinical rejection versus no‐rejection groups, the median (25th, 75th percentile) time to therapeutic tacrolimus levels was 9.5 (8, 12.3) days versus 9.0 (7, 13) days (p=0.623). The median time‐in‐therapeutic tacrolimus range was 34.1% (23.2, 42.2) versus 36.2% (19.9, 51.2), respectively (p=0.512). Similarly, we observed no significant differences in time to and time‐in‐therapeutic tacrolimus range in patients who developed grade 1R/1B (p=0.650 and p=0.725) or grade 2R or higher histology (p=0.632 and p=0.933).
Conclusions
Our small single‐center analysis suggests that neither time to nor time in therapeutic tacrolimus range predicted acute rejection within 30 days of HT. |
| doi_str_mv | 10.1002/phar.2262 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2194587218</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2214972369</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3532-d01202a039c9a30730dacb3905f4175ba14557faaec408f0a7638f3ec38fc59c3</originalsourceid><addsrcrecordid>eNp1kM1qGzEUhUVoady0i7xAEHTTLCa5kmas0dINSR0ItJjpWlzLdxKZ-as0Q_Cuj9Bn7JNUjpMsCt2cu_n4OPcwdirgQgDIy-EBw4WUc3nEZqLURWaEyN-wGUitMwAoj9n7GLcJFfNcvmPHCkojdQ4zdr-IsXceR993_AuNj0Qdr3xLf3799l2K6oECDjSN3vEKXegb306Rr7C7J47dhl9jaHZ8RVtyT5JFPVLgS8Iw8ipgF4cGu_EDe1tjE-nj8z1hP26uq6tldvft6-3V4i5zqlAy24CQIBGUcQYVaAUbdGtloKhzoYs1irwodI1ILoeyBtRzVdaKXEpXGKdO2OeDdwj9z4niaFsfHTWpA_VTtFKYvCi1FGVCP_2DbvspdKmdlVLkRks1N4k6P1Dp9RgD1XYIvsWwswLsfn27X9_u10_s2bNxWre0eSVf5k7A5QF49A3t_m-y35eL1ZPyLyknkH8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2214972369</pqid></control><display><type>article</type><title>Association Between Time‐in‐Therapeutic Tacrolimus Range and Early Rejection After Heart Transplant</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Baker, William L. ; Steiger, Samantha ; Martin, Spencer ; Patel, Nirav ; Radojevic, Joseph ; Darsaklis, Konstadina ; O'Bara, Lynn ; Kutzler, Heather ; Dougherty, James ; Feingold, Andrew ; Hammond, Jonathan ; Fusco, Daniel ; Gluck, Jason A</creator><creatorcontrib>Baker, William L. ; Steiger, Samantha ; Martin, Spencer ; Patel, Nirav ; Radojevic, Joseph ; Darsaklis, Konstadina ; O'Bara, Lynn ; Kutzler, Heather ; Dougherty, James ; Feingold, Andrew ; Hammond, Jonathan ; Fusco, Daniel ; Gluck, Jason A</creatorcontrib><description>Background
Historically, there is perceived pressure to achieve therapeutic levels of tacrolimus quickly after heart transplant (HT). We evaluated the association between time within therapeutic tacrolimus range and time to therapeutic trough and rejection in the 30 days following HT.
Methods
This is a single‐center retrospective cohort study of consecutive adult HT patients receiving immunosuppression. Goal trough tacrolimus levels were 10–15 ng/ml. Surveillance endomyocardial biopsies were performed weekly for 4 weeks. Outcomes included the effect of time to and time‐in‐therapeutic tacrolimus range (Rosendaal method) on 30‐day clinical rejection, 1R/1B, and 2R or higher histologic occurrences.
Results
We reviewed 67 HT patients (median age 58.8 yrs). For clinical rejection versus no‐rejection groups, the median (25th, 75th percentile) time to therapeutic tacrolimus levels was 9.5 (8, 12.3) days versus 9.0 (7, 13) days (p=0.623). The median time‐in‐therapeutic tacrolimus range was 34.1% (23.2, 42.2) versus 36.2% (19.9, 51.2), respectively (p=0.512). Similarly, we observed no significant differences in time to and time‐in‐therapeutic tacrolimus range in patients who developed grade 1R/1B (p=0.650 and p=0.725) or grade 2R or higher histology (p=0.632 and p=0.933).
Conclusions
Our small single‐center analysis suggests that neither time to nor time in therapeutic tacrolimus range predicted acute rejection within 30 days of HT.</description><identifier>ISSN: 0277-0008</identifier><identifier>EISSN: 1875-9114</identifier><identifier>DOI: 10.1002/phar.2262</identifier><identifier>PMID: 30892740</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Cohort Studies ; Drug Administration Schedule ; Female ; Graft rejection ; Graft Rejection - prevention & control ; Heart Transplantation ; Histology ; Historical account ; Humans ; Immunosuppression ; Immunosuppressive Agents - administration & dosage ; Immunosuppressive Agents - therapeutic use ; Male ; Middle Aged ; rejection ; Retrospective Studies ; Tacrolimus ; Tacrolimus - administration & dosage ; Tacrolimus - therapeutic use ; time‐in‐therapeutic range ; Treatment Outcome</subject><ispartof>Pharmacotherapy, 2019-05, Vol.39 (5), p.609-613</ispartof><rights>2019 Pharmacotherapy Publications, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-d01202a039c9a30730dacb3905f4175ba14557faaec408f0a7638f3ec38fc59c3</citedby><cites>FETCH-LOGICAL-c3532-d01202a039c9a30730dacb3905f4175ba14557faaec408f0a7638f3ec38fc59c3</cites><orcidid>0000-0003-2172-0931</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fphar.2262$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fphar.2262$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30892740$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baker, William L.</creatorcontrib><creatorcontrib>Steiger, Samantha</creatorcontrib><creatorcontrib>Martin, Spencer</creatorcontrib><creatorcontrib>Patel, Nirav</creatorcontrib><creatorcontrib>Radojevic, Joseph</creatorcontrib><creatorcontrib>Darsaklis, Konstadina</creatorcontrib><creatorcontrib>O'Bara, Lynn</creatorcontrib><creatorcontrib>Kutzler, Heather</creatorcontrib><creatorcontrib>Dougherty, James</creatorcontrib><creatorcontrib>Feingold, Andrew</creatorcontrib><creatorcontrib>Hammond, Jonathan</creatorcontrib><creatorcontrib>Fusco, Daniel</creatorcontrib><creatorcontrib>Gluck, Jason A</creatorcontrib><title>Association Between Time‐in‐Therapeutic Tacrolimus Range and Early Rejection After Heart Transplant</title><title>Pharmacotherapy</title><addtitle>Pharmacotherapy</addtitle><description>Background
Historically, there is perceived pressure to achieve therapeutic levels of tacrolimus quickly after heart transplant (HT). We evaluated the association between time within therapeutic tacrolimus range and time to therapeutic trough and rejection in the 30 days following HT.
Methods
This is a single‐center retrospective cohort study of consecutive adult HT patients receiving immunosuppression. Goal trough tacrolimus levels were 10–15 ng/ml. Surveillance endomyocardial biopsies were performed weekly for 4 weeks. Outcomes included the effect of time to and time‐in‐therapeutic tacrolimus range (Rosendaal method) on 30‐day clinical rejection, 1R/1B, and 2R or higher histologic occurrences.
Results
We reviewed 67 HT patients (median age 58.8 yrs). For clinical rejection versus no‐rejection groups, the median (25th, 75th percentile) time to therapeutic tacrolimus levels was 9.5 (8, 12.3) days versus 9.0 (7, 13) days (p=0.623). The median time‐in‐therapeutic tacrolimus range was 34.1% (23.2, 42.2) versus 36.2% (19.9, 51.2), respectively (p=0.512). Similarly, we observed no significant differences in time to and time‐in‐therapeutic tacrolimus range in patients who developed grade 1R/1B (p=0.650 and p=0.725) or grade 2R or higher histology (p=0.632 and p=0.933).
Conclusions
Our small single‐center analysis suggests that neither time to nor time in therapeutic tacrolimus range predicted acute rejection within 30 days of HT.</description><subject>Cohort Studies</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Graft rejection</subject><subject>Graft Rejection - prevention & control</subject><subject>Heart Transplantation</subject><subject>Histology</subject><subject>Historical account</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>rejection</subject><subject>Retrospective Studies</subject><subject>Tacrolimus</subject><subject>Tacrolimus - administration & dosage</subject><subject>Tacrolimus - therapeutic use</subject><subject>time‐in‐therapeutic range</subject><subject>Treatment Outcome</subject><issn>0277-0008</issn><issn>1875-9114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM1qGzEUhUVoady0i7xAEHTTLCa5kmas0dINSR0ItJjpWlzLdxKZ-as0Q_Cuj9Bn7JNUjpMsCt2cu_n4OPcwdirgQgDIy-EBw4WUc3nEZqLURWaEyN-wGUitMwAoj9n7GLcJFfNcvmPHCkojdQ4zdr-IsXceR993_AuNj0Qdr3xLf3799l2K6oECDjSN3vEKXegb306Rr7C7J47dhl9jaHZ8RVtyT5JFPVLgS8Iw8ipgF4cGu_EDe1tjE-nj8z1hP26uq6tldvft6-3V4i5zqlAy24CQIBGUcQYVaAUbdGtloKhzoYs1irwodI1ILoeyBtRzVdaKXEpXGKdO2OeDdwj9z4niaFsfHTWpA_VTtFKYvCi1FGVCP_2DbvspdKmdlVLkRks1N4k6P1Dp9RgD1XYIvsWwswLsfn27X9_u10_s2bNxWre0eSVf5k7A5QF49A3t_m-y35eL1ZPyLyknkH8</recordid><startdate>201905</startdate><enddate>201905</enddate><creator>Baker, William L.</creator><creator>Steiger, Samantha</creator><creator>Martin, Spencer</creator><creator>Patel, Nirav</creator><creator>Radojevic, Joseph</creator><creator>Darsaklis, Konstadina</creator><creator>O'Bara, Lynn</creator><creator>Kutzler, Heather</creator><creator>Dougherty, James</creator><creator>Feingold, Andrew</creator><creator>Hammond, Jonathan</creator><creator>Fusco, Daniel</creator><creator>Gluck, Jason A</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2172-0931</orcidid></search><sort><creationdate>201905</creationdate><title>Association Between Time‐in‐Therapeutic Tacrolimus Range and Early Rejection After Heart Transplant</title><author>Baker, William L. ; Steiger, Samantha ; Martin, Spencer ; Patel, Nirav ; Radojevic, Joseph ; Darsaklis, Konstadina ; O'Bara, Lynn ; Kutzler, Heather ; Dougherty, James ; Feingold, Andrew ; Hammond, Jonathan ; Fusco, Daniel ; Gluck, Jason A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-d01202a039c9a30730dacb3905f4175ba14557faaec408f0a7638f3ec38fc59c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Cohort Studies</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Graft rejection</topic><topic>Graft Rejection - prevention & control</topic><topic>Heart Transplantation</topic><topic>Histology</topic><topic>Historical account</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>rejection</topic><topic>Retrospective Studies</topic><topic>Tacrolimus</topic><topic>Tacrolimus - administration & dosage</topic><topic>Tacrolimus - therapeutic use</topic><topic>time‐in‐therapeutic range</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baker, William L.</creatorcontrib><creatorcontrib>Steiger, Samantha</creatorcontrib><creatorcontrib>Martin, Spencer</creatorcontrib><creatorcontrib>Patel, Nirav</creatorcontrib><creatorcontrib>Radojevic, Joseph</creatorcontrib><creatorcontrib>Darsaklis, Konstadina</creatorcontrib><creatorcontrib>O'Bara, Lynn</creatorcontrib><creatorcontrib>Kutzler, Heather</creatorcontrib><creatorcontrib>Dougherty, James</creatorcontrib><creatorcontrib>Feingold, Andrew</creatorcontrib><creatorcontrib>Hammond, Jonathan</creatorcontrib><creatorcontrib>Fusco, Daniel</creatorcontrib><creatorcontrib>Gluck, Jason A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baker, William L.</au><au>Steiger, Samantha</au><au>Martin, Spencer</au><au>Patel, Nirav</au><au>Radojevic, Joseph</au><au>Darsaklis, Konstadina</au><au>O'Bara, Lynn</au><au>Kutzler, Heather</au><au>Dougherty, James</au><au>Feingold, Andrew</au><au>Hammond, Jonathan</au><au>Fusco, Daniel</au><au>Gluck, Jason A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Time‐in‐Therapeutic Tacrolimus Range and Early Rejection After Heart Transplant</atitle><jtitle>Pharmacotherapy</jtitle><addtitle>Pharmacotherapy</addtitle><date>2019-05</date><risdate>2019</risdate><volume>39</volume><issue>5</issue><spage>609</spage><epage>613</epage><pages>609-613</pages><issn>0277-0008</issn><eissn>1875-9114</eissn><abstract>Background
Historically, there is perceived pressure to achieve therapeutic levels of tacrolimus quickly after heart transplant (HT). We evaluated the association between time within therapeutic tacrolimus range and time to therapeutic trough and rejection in the 30 days following HT.
Methods
This is a single‐center retrospective cohort study of consecutive adult HT patients receiving immunosuppression. Goal trough tacrolimus levels were 10–15 ng/ml. Surveillance endomyocardial biopsies were performed weekly for 4 weeks. Outcomes included the effect of time to and time‐in‐therapeutic tacrolimus range (Rosendaal method) on 30‐day clinical rejection, 1R/1B, and 2R or higher histologic occurrences.
Results
We reviewed 67 HT patients (median age 58.8 yrs). For clinical rejection versus no‐rejection groups, the median (25th, 75th percentile) time to therapeutic tacrolimus levels was 9.5 (8, 12.3) days versus 9.0 (7, 13) days (p=0.623). The median time‐in‐therapeutic tacrolimus range was 34.1% (23.2, 42.2) versus 36.2% (19.9, 51.2), respectively (p=0.512). Similarly, we observed no significant differences in time to and time‐in‐therapeutic tacrolimus range in patients who developed grade 1R/1B (p=0.650 and p=0.725) or grade 2R or higher histology (p=0.632 and p=0.933).
Conclusions
Our small single‐center analysis suggests that neither time to nor time in therapeutic tacrolimus range predicted acute rejection within 30 days of HT.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30892740</pmid><doi>10.1002/phar.2262</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0003-2172-0931</orcidid></addata></record> |
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| ispartof | Pharmacotherapy, 2019-05, Vol.39 (5), p.609-613 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Cohort Studies Drug Administration Schedule Female Graft rejection Graft Rejection - prevention & control Heart Transplantation Histology Historical account Humans Immunosuppression Immunosuppressive Agents - administration & dosage Immunosuppressive Agents - therapeutic use Male Middle Aged rejection Retrospective Studies Tacrolimus Tacrolimus - administration & dosage Tacrolimus - therapeutic use time‐in‐therapeutic range Treatment Outcome |
| title | Association Between Time‐in‐Therapeutic Tacrolimus Range and Early Rejection After Heart Transplant |
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