LCP-Tacrolimus Extended-Release (Envarsus XR) Use in Adolescent and Young Adult Solid Organ Transplant Recipients

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-08-01 DOI:10.1111/ctr.15417

Esther K. Bae, Mary Moss Chandran, Melanie D. Everitt, Eric Benz, Margret Bock

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引用次数: 0

Abstract

Introduction

Limited published experience describes once daily, extended-release tacrolimus (LCP-Tac) use in pediatric solid organ transplantation (SOT), particularly nonrenal SOT. LCP-Tac can simplify immunosuppression (IS) regimens, minimize immediate release-tacrolimus (IR-Tac)-associated adverse effects, and promote adherence. This study describes the successful use of LCP-Tac in adolescent and young adult (AYA) SOT populations.

Methods

A single-center, retrospective chart review of AYA SOT recipients (age < 25 years) converted from IR-Tac to LCP-Tac. Graft survival, biopsy-proven acute rejection (BPAR), infection rates, estimated glomerular filtration rate (eGFR), and pill burden were assessed at five time points postconversion (1, 3, 6, 12, and 24 months). Intrapatient variability of tacrolimus, as assessed by coefficient of variability (CV%), was also analyzed.

Results

Twenty-nine AYA SOT recipients (19 heart, 6 kidney, and 4 liver) were converted to LCP-Tac, with a median age of 17.4 years at conversion. Conversion, mainly due to perceived or identified medication nonadherence, occurred at a median of 5.4 years posttransplant. No graft loss occurred within 24 months of conversion, and BPAR incidence rate was consistent with previous reports for these populations. Only one patient experienced CMV infection. Renal function remained stable postconversion.

Conclusion

Successful conversion from IR-Tac to LCP-Tac was demonstrated in AYA heart, kidney, and liver transplant recipients. These AYA SOT recipients experienced reduced pill burden and improved tacrolimus trough concentration variability. However, the impact on medication adherence warrants further investigation. Future research should explore the targeted use of LCP-Tac to enhance IS tolerability and medication adherence in young SOT populations.

查看原文本刊更多论文

LCP-他克莫司缓释剂（Envarsus XR）在青少年和年轻成人实体器官移植受者中的应用。

简介：已发表的关于在儿科实体器官移植（SOT）中使用每日一次缓释他克莫司（LCP-Tac）的经验有限，尤其是在非肾脏移植中。LCP-Tac可简化免疫抑制（IS）方案，最大限度地减少速释他克莫司（IR-Tac）相关不良反应，并提高依从性。本研究介绍了在青少年和年轻成人（AYA）SOT人群中成功使用LCP-Tac的情况：方法：对从 IR-Tac 转为 LCP-Tac 的青少年 SOT 受者（年龄小于 25 岁）进行单中心回顾性病历审查。在转换后的五个时间点（1、3、6、12 和 24 个月）评估了移植物存活率、活组织检查证实的急性排斥反应（BPAR）、感染率、估计肾小球滤过率（eGFR）和药片负担。此外，还分析了以变异系数（CV%）评估的患者体内他克莫司的变异性：结果：29 名亚健康 SOT 受体（19 名心脏受体、6 名肾脏受体和 4 名肝脏受体）转为 LCP-Tac，转为 LCP-Tac 时的中位年龄为 17.4 岁。移植后中位年龄为 17.4 岁，主要因认为或确定的不遵医嘱用药而改用 LCP-Tac，中位时间为移植后 5.4 年。移植后 24 个月内没有发生移植物丢失，BPAR 发生率与之前关于这些人群的报告一致。只有一名患者发生了 CMV 感染。肾功能在转换后保持稳定：结论：亚裔心脏、肾脏和肝脏移植受者成功地从 IR-Tac 转为 LCP-Tac。这些青壮年器官移植受者的用药负担减轻，他克莫司谷浓度变异性提高。不过，对用药依从性的影响还有待进一步研究。未来的研究应探索有针对性地使用 LCP-Tac 来提高年轻 SOT 群体的 IS 耐受性和用药依从性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.