Evaluating the conversion to extended-release tacrolimus from immediate-release tacrolimus in liver transplant recipients

Choi, David; Thaker, Sarang; West-Thielke, Patricia; Elmasri, Annesti; Chan, Christine

doi:10.1097/meg.0000000000002172

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…Six recipients experienced graft loss within 30 d of transplant, attributed to vascular complications, graft selection, and one case of postoperative hemorrhage, the details of which are described elsewhere. 22 The median recipient age at UTx was 31 y (range, [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], and most were Caucasian (n = 12, 86%). The indication for UTx was absolute uterinefactor infertility in all cases, with 13 (93%) diagnosed with congenital agenesis of the uterus (MRKH).…”

Section: Resultsmentioning

confidence: 99%

“…Proposed benefits of XR-Tac are a more favorable pharmacokinetic profile with reduced peak tacrolimus concentrations, allowing the potential for reduced toxicity and improved medication adherence is given that it is a once-daily dose compared with IR-Tac. 27,28 The dosage of tacrolimus was gradually reduced and kept at the target trough in recipients during pregnancy. Despite the lower levels, we only experienced 1 episode of rejection during pregnancy (case 20, GW 12), which was responsive to steroids.…”

Section: Discussionmentioning

confidence: 99%

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Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study

et al. 2023

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Original Clinical Science-General Background. Uterus transplantation is a temporary transplant allowing women with absolute uterine factor infertility to experience pregnancy and childbirth. The degree of immunosuppression (IS) required to prevent rejection while minimizing toxicity to the recipient and fetus remains an area of investigation. Methods. In this article, we describe immunosuppressive therapy, rejection episodes, infections, and adverse events in 14 uterus transplant recipients. Induction consisted of antithymocyte globulin and methylprednisolone. Ten recipients (71%) received no steroids postoperatively, and 4 (29%) had steroids tapered off at 42 d. All received oral tacrolimus, either immediate release (n = 2, 14%) or extended release (n = 12, 86%). Mycophenolate was used in 4 cases (29%), de novo azathioprine in 9 (64%), and de novo everolimus in 1 (7%).Results. Sixteen clinically silent, treatment-responsive rejection episodes occurred in 10 recipients. Five recipients (36%) experienced acute kidney injury. In 3 recipients, IS was discontinued due to renal dysfunction. Eleven infection episodes were noted in 7 recipients. No babies had congenital abnormalities. Conclusions. Our experience demonstrates that safe IS regimens can be used for uterus transplant recipients before and during pregnancy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study

et al. 2023

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“…75 When used as conversion therapy in a retrospective study of 25 patients recieving basiliximab induction with or without MMF, no rejection had occurred within 3 months of conversion. 76 Considering pharmacokinetics, LCPT demonstrated a more consistent profile with lower C max and peak-trough fluctuation when converted from IR-TAC. Overall AUC was similar to IR-TAC at a 30% lower TDD with no new safety concerns occurred within 1 year of follow-up.…”

Section: Calcineurin Inhibitorsmentioning

confidence: 89%

“…In a randomized open‐label study of 58 de novo liver transplant patients, freedom from acute rejection at day 180 and 360 was similar with LCPT versus IR‐TAC (79% vs. 87% and 74% vs. 82%, respectively) 75 . When used as conversion therapy in a retrospective study of 25 patients recieving basiliximab induction with or without MMF, no rejection had occurred within 3 months of conversion 76 . Considering pharmacokinetics, LCPT demonstrated a more consistent profile with lower C max and peak‐trough fluctuation when converted from IR‐TAC.…”

Section: Clinical Questions and Recommendationsmentioning

confidence: 96%

Consensus recommendations for use of maintenance immunosuppression in solid organ transplantation: Endorsed by the American College of Clinical Pharmacy, American Society of Transplantation, and the International Society for Heart and Lung Transplantation

et al. 2022

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Advances in maintenance immunosuppression over the past three decades have improved solid organ transplantation outcomes dramatically. Uninterrupted access to immunosuppression is paramount to minimize rejection and maintain allograft and patient survival. There is no standardized approach to maintenance immunosuppression management. Agents used vary based on transplanted organ, center‐specific protocol, provider expertise, insurance formularies, ability to cover co‐pays, recipient characteristics and tolerability. Published data reflects this heterogeneity. Despite this limitation, maintenance immunosuppression usage cross pollinates between organ groups with standard of care agents often being used off‐label, making medication access a challenge for many transplant recipients. A multidisciplinary panel of American transplant clinicians was formed to review published literature on maintenance immunosuppression with the goal to formulate consensus recommendations for their use in specific organ groups. These consensus recommendations are intended to provide transplant clinicians with a summary of literature on maintenance immunosuppression in the modern era and to support transplant team members working to secure medication access for patients.

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“…In one study, common reasons patients were switched to extended-release tacrolimus were wide fluctuations in tacrolimus levels (44%) and to minimize the adverse effects of tremors (32%). Among patients who were switched due to tremors, 88% reported significant improvement in symptoms [ 25 ]. Another study with open-label assessments also reported similar tremor improvements when patients switched from immediate release to sustained release tacrolimus [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Phenomenology and Physiology of Tacrolimus Induced Tremor

Shukla

Lunny

Hisham

et al. 2023

Tremor and Other Hyperkinetic Movements

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Background: Tacrolimus is a potent immunosuppressant drug commonly used after solid organ transplant surgery. The use of this drug is frequently associated with the emergence of tremors. There is little information on the clinical and physiological characteristics of tacrolimus-induced tremors. Characterizing these tremors is essential as they can promote the development of specific therapies. Methods: We describe four patients placed on tacrolimus immunosuppressant therapy following kidney transplant surgery and who developed tremors impacting their daily functional activities. We describe the clinical and physiological characteristics of the tremor and the response generated after a limb cooling test. Results: A postural and kinetic tremor mainly involving the distal hands was observed in our cohort. In the accelerometer-based assessment, the tremor amplitude was noted to be mild to moderate, and the frequency was 5–6 Hz. Cooling the forearm and the hand led to a temporary albeit significant reduction of tremor amplitude (p = 0.03). Limb cooling lowered the tremor frequency by 1 Hz in two patients with no change in the other two patients, and the statistical comparison was not significant (p > 0.05). Conclusions: Limb cooling may be pursued as a therapeutic option for addressing tacrolimus-induced tremor, as the patients in our cohort benefitted from temporary tremor suppression.

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Evaluating the conversion to extended-release tacrolimus from immediate-release tacrolimus in liver transplant recipients

Cited by 7 publications

References 18 publications

Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study

Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study

Consensus recommendations for use of maintenance immunosuppression in solid organ transplantation: Endorsed by the American College of Clinical Pharmacy, American Society of Transplantation, and the International Society for Heart and Lung Transplantation

Phenomenology and Physiology of Tacrolimus Induced Tremor

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