{"title":"接受巴利昔单抗诱导治疗的心脏移植受者在服用他克莫司后出现早期急性肾损伤。","authors":"Megumi Ikura, Tsutomu Nakamura, Kyoichi Wada, Rikako Nagata, Tomoko Ueno, Kazuyoshi Kawabata, Fumiki Yoshihara, Takuya Watanabe, Yasumasa Tsukamoto","doi":"10.5414/CP204586","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>In this study, we aimed to analyze the association among the timing of tacrolimus initiation, time required to reach the target blood concentration, and early acute kidney injury (AKI) after tacrolimus administration in heart transplant recipients who received basiliximab induction therapy.</p><p><strong>Materials and methods: </strong>88 patients treated with tacrolimus-based immunosuppressive therapy were retrospectively reviewed. Induction therapy was administered to 52 patients. AKI was evaluated within 7 days of tacrolimus administration.</p><p><strong>Results: </strong>The rate of increase in tacrolimus trough concentration to the target trough concentration of 10 µg/mL early after its administration was set to be similar in the basiliximab induction and non-induction group; 8 and 2 patients developed AKI in the induction and non-induction group, respectively. In the induction group, there was no significant difference in the timing of tacrolimus initiation and the time required to reach the target concentration between patients who developed and did not develop AKI. In contrast, the cumulative incidence of AKI was significantly different between patients with an estimated glomerular filtration rate below and those with an estimated glomerular filtration rate above 43 mL/min/1.73m<sup>2</sup> at the start of tacrolimus administration (37.5% and 11.4%, respectively; p = 0.045).</p><p><strong>Conclusion: </strong>In patients receiving basiliximab induction therapy, the timing of tacrolimus initiation and the time to reach the target concentration are unlikely to be associated with early AKI after tacrolimus administration. However, the recovery of sufficient renal function after heart transplantation is important for determining the start time of tacrolimus.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":null,"pages":null},"PeriodicalIF":0.9000,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Early acute kidney injury after tacrolimus administration in heart transplant recipients receiving basiliximab induction therapy.\",\"authors\":\"Megumi Ikura, Tsutomu Nakamura, Kyoichi Wada, Rikako Nagata, Tomoko Ueno, Kazuyoshi Kawabata, Fumiki Yoshihara, Takuya Watanabe, Yasumasa Tsukamoto\",\"doi\":\"10.5414/CP204586\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>In this study, we aimed to analyze the association among the timing of tacrolimus initiation, time required to reach the target blood concentration, and early acute kidney injury (AKI) after tacrolimus administration in heart transplant recipients who received basiliximab induction therapy.</p><p><strong>Materials and methods: </strong>88 patients treated with tacrolimus-based immunosuppressive therapy were retrospectively reviewed. Induction therapy was administered to 52 patients. AKI was evaluated within 7 days of tacrolimus administration.</p><p><strong>Results: </strong>The rate of increase in tacrolimus trough concentration to the target trough concentration of 10 µg/mL early after its administration was set to be similar in the basiliximab induction and non-induction group; 8 and 2 patients developed AKI in the induction and non-induction group, respectively. In the induction group, there was no significant difference in the timing of tacrolimus initiation and the time required to reach the target concentration between patients who developed and did not develop AKI. In contrast, the cumulative incidence of AKI was significantly different between patients with an estimated glomerular filtration rate below and those with an estimated glomerular filtration rate above 43 mL/min/1.73m<sup>2</sup> at the start of tacrolimus administration (37.5% and 11.4%, respectively; p = 0.045).</p><p><strong>Conclusion: </strong>In patients receiving basiliximab induction therapy, the timing of tacrolimus initiation and the time to reach the target concentration are unlikely to be associated with early AKI after tacrolimus administration. However, the recovery of sufficient renal function after heart transplantation is important for determining the start time of tacrolimus.</p>\",\"PeriodicalId\":13963,\"journal\":{\"name\":\"International journal of clinical pharmacology and therapeutics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2024-08-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International journal of clinical pharmacology and therapeutics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5414/CP204586\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International journal of clinical pharmacology and therapeutics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5414/CP204586","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
摘要
研究目的在这项研究中,我们旨在分析接受巴利昔单抗诱导治疗的心脏移植受者在使用他克莫司后,开始使用他克莫司的时间、达到目标血药浓度所需的时间和早期急性肾损伤(AKI)之间的关联。52名患者接受了诱导治疗。在使用他克莫司的 7 天内对 AKI 进行了评估:巴利昔单抗诱导组和非诱导组的他克莫司谷浓度在用药后早期升至目标谷浓度 10 µg/mL 的比率相似;诱导组和非诱导组分别有 8 名和 2 名患者发生了 AKI。在诱导组中,发生和未发生 AKI 的患者在开始使用他克莫司的时间和达到目标浓度所需的时间上没有明显差异。相反,在开始使用他克莫司时,估计肾小球滤过率低于43 mL/min/1.73m2的患者和估计肾小球滤过率高于43 mL/min/1.73m2的患者之间,AKI的累积发生率有显著差异(分别为37.5%和11.4%;P = 0.045):结论:在接受巴利昔单抗诱导治疗的患者中,他克莫司的起始时间和达到目标浓度的时间不太可能与他克莫司用药后的早期 AKI 相关。然而,心脏移植后肾功能的充分恢复对于确定他克莫司的起始时间非常重要。
Early acute kidney injury after tacrolimus administration in heart transplant recipients receiving basiliximab induction therapy.
Objective: In this study, we aimed to analyze the association among the timing of tacrolimus initiation, time required to reach the target blood concentration, and early acute kidney injury (AKI) after tacrolimus administration in heart transplant recipients who received basiliximab induction therapy.
Materials and methods: 88 patients treated with tacrolimus-based immunosuppressive therapy were retrospectively reviewed. Induction therapy was administered to 52 patients. AKI was evaluated within 7 days of tacrolimus administration.
Results: The rate of increase in tacrolimus trough concentration to the target trough concentration of 10 µg/mL early after its administration was set to be similar in the basiliximab induction and non-induction group; 8 and 2 patients developed AKI in the induction and non-induction group, respectively. In the induction group, there was no significant difference in the timing of tacrolimus initiation and the time required to reach the target concentration between patients who developed and did not develop AKI. In contrast, the cumulative incidence of AKI was significantly different between patients with an estimated glomerular filtration rate below and those with an estimated glomerular filtration rate above 43 mL/min/1.73m2 at the start of tacrolimus administration (37.5% and 11.4%, respectively; p = 0.045).
Conclusion: In patients receiving basiliximab induction therapy, the timing of tacrolimus initiation and the time to reach the target concentration are unlikely to be associated with early AKI after tacrolimus administration. However, the recovery of sufficient renal function after heart transplantation is important for determining the start time of tacrolimus.
期刊介绍:
The International Journal of Clinical Pharmacology and Therapeutics appears monthly and publishes manuscripts containing original material with emphasis on the following topics: Clinical trials, Pharmacoepidemiology - Pharmacovigilance, Pharmacodynamics, Drug disposition and Pharmacokinetics, Quality assurance, Pharmacogenetics, Biotechnological drugs such as cytokines and recombinant antibiotics. Case reports on adverse reactions are also of interest.