ESPN 50th Annual Meeting

ESPN 2017


 
TACROLIMUS VARIABILITY: A CAUSE OF DONOR SPECIFIC ANTIBODY FORMATION IN RENAL TRANSPLANTATION?
GÜLŞAH KAYA AKSOY 1 ELIF ÇOMAK 1 MUSTAFA KOYUN 1 HALİDE AKBAS 2 BÜLENT AYDINLI 3 FAHRI UCAR 4 SEMA AKMAN 1

1- AKDENIZ UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF PEDIATRICS, ANTALYA, TURKEY
2- AKDENIZ UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF BIOCHEMISTRY, ANTALYA, TURKEY
3- AKDENIZ UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF GENERAL SURGERY, ANTALYA, TURKEY
4- AKDENIZ UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF MEDICAL BIOLOGY, ANTALYA, TURKEY
 
Introduction:

Immunsupresive drug compliance is required for long-term graft survey in renal transplant recipients. Tacrolimus is one of the major immunsupresive agents and fluctuations of blood levels may lead to antibody development. The aim of the study was to investigate whether tacrolimus variability is an effective factor for antibody development and graft survival in pediatric renal transplant recipients.

Material and methods:

Pediatric living-donor renal transplant recipients followed-up at our center at the last two years and who were using tacrolimus were retrospectively evaluated. Patients who had pretransplant donor spesific antibodies (DSA) were excluded. Tacrolimus blood levels, serum creatinine and DSA were recorded. Estimated glomerular filtration rate (eGFR) were calculated using Schwarz formula. Tacrolimus variability (Tac CV=standard deviation of mean/mean) was calculated separately at the first post-transplant 6 months, between 6-12 months and from the end of the first year to the last follow-up period. Renal biopsy was performed in all patients with positive DSA.

Results:

A total of 65 patients, 48 males (73.8%), with a mean age of 15.16±4.43 years, were included in the study. The mean age at the time of transplantation was 11.20±3.88 years and mean follow-up period was 50.82±26.84 years. DSA positivity was detected in 12 patients (18.4%). eGFRs were similar between DSA negative and positive groups (78.72±2.86 vs 77.45±8.08, respectively; p>0.05). HLA mismatches >3, presence of acute celluler rejection, Tac CV at post-tx 6-12 months and >12 months were found to be significant factors associated with the development of DSA. According to the logistic regression analysis, Tac CV>0.3 at post-tx 6-12 months was associated with the development of DSA (B:1.440, p= 0.046). Also, Tac CV>0.3 at post-tx 6-12 months negatively correlated with eGFR. Within recipients who underwent renal biopsy, mean Tac CV over 12 months were significantly higher in IF/TA positive patients than IF/TA negative patients (6.58 ±0.44 vs 6.29±0.20, respectively; p=0.031)

Conclusions:

Tacrolimus variability was associated with DSA formation and negatively correlated with estimated glomerular filtration rate in pediatric living-donor renal transplant recipients. We suggest to calculate tacrolimus variability in all pediatric living-donor renal transplant recipients.