Bootcongres

Background. A high intra-patient variability in tacrolimus (Tac) clearance was found to be associated with poor graft survival after kidney transplantation. We hypothesized that a high intra-patient variability of Tac clearance after heart transplantation may be associated with progression of cardiac allograft vasculopathy (CAV) as a determinant of long-term survival of heart transplant recipients. Methods. 72 heart transplant recipients were included. Patients underwent coronary angiography at year 1 and 4 after transplantation and were divided according to low and high intra-patient variability of Tac clearance, with the median variability as cut-off. Primary outcome was the association between intra-patient variability of Tac clearance and the progression of CAV score between year 1 and 4. Secondary outcome was this association with acute cellular rejection. Results. There was no significant difference the group of 10 patients with progression of CAV and the group of 62 patients without CAV (20% vs 55%, respectively, p=0.08). There was no significant difference between the proportion of patients with high intra-patient Tac variability between the group of 52 patients with one or more acute cellular rejection and the group of 20 patients without rejection (52% vs 45%, respectively, p=0.79). 

Conclusion. A high intra-patient variability in Tac pharmacokinetics was not associated with progression of CAV nor with acute cellular rejection in heart transplant recipients. The frequent use of 3 immunosuppressive drugs after heart transplantation may protect against the adverse effects of a high intra-patient variability of Tac clearance.