Background and importance In solid organ transplant patients, intrapatient variability in tacrolimus levels >30% is related to the appearance of specific de novo donor antibodies (dn-DSA) and rejection.
Aim and objectives We wanted to determine if in a cohort of 71 lung transplant patients in 2018 and 2019 this variability is also related to the appearance of post-transplant complications: diabetes, osteoporosis, renal failure, dyslipidaemia and if the sex of the patients and their pre-transplant diagnosis has an influence.
Material and methods Through the hospital’s own lung transplant patient management programme and the hospital’s assisted electronic prescription, the following data were retrospectively analysed: tacrolimus levels from the second post-transplant month and its percentage coefficient of variation (% CV) until December 2020 (% CV: (standard deviation/mean)*100); tacrolimus, prednisone and mycophenolate mofetil dose; onset of diabetes and the drug being treated; glomerular filtration rate (GFR) <60 mL/min/1.73 m2; onset of osteoporosis; appearance of dyslipidaemia; sex; age; and pre-transplant diagnosis. For the statistical analysis, SPSS v.22 was used.
Results Of the 71 lung transplant patients in 2018, 8 died, 21 (30%) were women, 38 (54%) had a% CV of tacrolimus >30%, 32 (45%) had GFR <60 mL/min/1.73 m2, 28 (39%) had osteoporosis, 47 (66%) ha dyslipidaemia and 21 (29%) had diabetes.
The drugs used in the treatment of osteoporosis were: zoledronic acid, denosumab and teriparatide; dyslipidaemia: atorvastatin; and diabetes: metformin and insulin.
After the statistical analysis performed using the CHI2 test, no statistically significant differences were obtained between the% CV of tacrolimus and the remainder of the variables. The statistical significance in each case was: GFR <60 mL/min (p=0.111), osteoporosis (p=0.202), dyslipidaemia (p=0.353), diabetes (p=0.361), pre-transplant diagnosis (p=0.455), age (p=0.720) and sex (p=0.812).
Conclusion and relevance The% CV of tacrolimus >30% is not related to the appearance of post-transplant complications in a statistically significant way in this cohort of 71 lung transplant patients. There is a positive trend towards the development of kidney failure. More studies are needed and with a larger number of patients to be able to draw more precise conclusions.
Conflict of interest No conflict of interest
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