Encore Presentations
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Purpose:
LCP-tacrolimus (LCPT) is approved for use in kidney transplant but data for use
in other organ transplantation is limited. We sought to assess the utility of
converting immediate-release tacrolimus (IR-Tac) to LCPT in non-kidney
transplant recipients and to determine the appropriateness of the standard
conversion ratio of 1:0.8.
Methods:
This was a single-center, retrospective, cohort study of adult, non-kidney
transplant recipients between June 2015 to Aug 2022 who were converted to LCPT with
at least 3 months follow-up. The primary outcome was conversion ratio based on
presence or absence of concomitant CYP3A4 inhibitor therapy (CIT). Other
outcomes assessed were indication for conversion, conversion ratio based on
organ transplanted, and incidence of AKI.
Results:
A total of 116 patients were included; 23 (19.8%) of the patients were on CIT. Baseline
characteristics were similar between groups, except a larger proportion of lung
transplant recipients were on CIT versus no CIT (26.1% vs 5.4%, p = 0.013). The
median IR-Tac total daily dose at conversion was 5 mg (IQR 2-8). The median LCPT
total daily dose was 4 mg (IQR 2-6). The median conversion ratio was similar
between patients on CIT and patients not on CIT; 1:0.75 (IQR 0.50 – 0.88) vs
1:0.75 (IQR 0.75 – 0.83). The median LCPT dose was lower in patients who were on
CIT compared to those who were not; 2 mg (IQR 0.75- 4) vs 4 mg (IQR 2.25- 8) (p=0.006).
A total of 57.1% patients achieved target tacrolimus trough concentration at 1-week
post-conversion and 62.5% at 1-month post-conversion.
The
CIT group had higher dose-normalized tacrolimus trough concentrations pre- and
post-conversion (Figure 1). There was no difference in the percentage of
patients at goal at week 0, week 1, or month 1 between patients on CIT and
patients not on CIT. There was no difference in the incidence of post-conversion
AKI between groups.
Conclusions:
These findings demonstrate that the standard conversion ratio of IR-Tac to LCPT
can be used in non-renal transplant recipients without increasing AKI risk
regardless of concomitant CIT. CIT resulted in higher dose-normalized
tacrolimus concentrations for LCPT similar to IR-Tac.
|
Table 1. Baseline characteristics:
|
|
Whole Cohort
(n = 116)
|
No Concomitant CYP3A4 Inhibitor
(n = ?93)
|
Concomitant CYP3A4 Inhibitor
(n = 23)
|
p–value ?
|
|
Type of transplant?
Heart?
Lung?
Liver?
Heart-kidney?
Liver-kidney?
|
71?(61.2%)
11?(9.5%)
24?(20.7%)
8?(6.9%)
2?(1.7%)
|
57 (61.3%)
5?(5.4%)
23?(24.7%)
6?(6.5%)
2?(2.1%)
|
14?(60.9%)
6?(26.1%)
1?(4.3%)
2?(8.7%)
0
|
NS
0.013?
NS
NS
NS
|
|
Gender?
Male?
|
82 (70.7%)
|
67 (72.0%)
|
15?(65.2%)
|
NS
|
|
Ethnicity?
Caucasian?
African American?
Hispanic?
Asian?
Other
|
58 (50.0%)
20 (17.0%)
25 (21.6%)
7 (6.0 %)
6 (5.4%)
|
49?(52.7%)
13 (14.0%)
19 (20.3%)
6 (6.5%)
6 (6.5%)
|
9 (39.1%)
7 (30.4%)
6 (26.1%)
1 (4.4%)
0
|
NS?
|
|
Reason for Switch?
??????????? Neurotoxicity?
??????????? Adherence?
??????????? High Peak?
??????????? Finance?
??????????? Other?
|
55 (47.4%)
30?(25.9%)
11?(9.5%)
3?(2.6%)
17?(14.7%)
|
45?(48.4%)
22?(23.7%)
7?(7.5%)
3?(3.23%)
16?(17.2%)
|
10?(43.5%)
8?(34.8%)
4?(17.4%)
0
1 ?(4.3%)
|
NS
|
|
CYP3A4 Inhibitor Type?
Isavuconazole?
Fluconazole?
Posaconazole?
Diltiazem?
|
|
|
2?(8.7%)
8?(34.8%)
12?(52.2%)
1?(4.3%)
|
?
|
|
Patient at goal trough prior to conversion?
|
62 (54.9%)
|
49 (54.4%)
|
13 (56.5%)
|
NS?
|
|
?Age (years) median, IQR
|
60.8 (52.2, 66.1)
|
60.8 (51.4, 65.2)
|
60.9 (53.3, 66.8)
|
NS
|
|
Weight (kg) median, IQR
|
78.1 (66.0, 90.1)
|
78.9 (65.7, 90.3)
|
76.2 (66.7, 88.4)
|
NS
|
|
Time from transplant to conversion (median days)
|
108.5 (51.5, 434.5)
|
111.0 (51.0, 436.0)
|
106.0 (53.0, 320.0)
|
NS
|
Figure 1: Dose-normalized
tacrolimus trough concentration comparison pre- and post-conversion
Presenting Author
Ashley Feist PharmDUniversity of California San Diego
Authors
Janice Kerr PharmD
UC San Diego Health
Thu Le PharmD
Stanford Health Care
Alicia Lichvar PharmD
UC San Diego Health
Stefani Lucarelli PharmD
UC San Diego Health
Shirley Tsunoda PharmD
UC San Diego