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首页> 外文期刊>journal of pharmaceutical health care and sciences >Association between time in therapeutic range of tacrolimus blood concentration and acute rejection within the first three months after lung transplantation
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Association between time in therapeutic range of tacrolimus blood concentration and acute rejection within the first three months after lung transplantation

机译：他克莫司血药浓度治疗范围内的时间与肺移植后前三个月内急性排斥反应之间的关联

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Background Tacrolimus is a key drug in immunosuppressive therapy following lung transplantation. The blood tacrolimus levels are likely to fluctuate in the early postoperative period, and failure to maintain the tacrolimus trough level in target ranges is a risk factor for rejection. However, there is little information about the relationship between the time in therapeutic range (TTR) of the tacrolimus trough level (tacrolimus TTR) and clinical outcomes. This study aimed to evaluate the association between tacrolimus TTR and acute rejection (AR) within the first three months after lung transplantation. Methods This was a retrospective study of patients who underwent lung transplantation at a single center. The target tacrolimus trough levels were 10-15 ng/mL, and tacrolimus TTR was calculated using the Rosendaal method. The cut-off value of the tacrolimus TTR was estimated by receiver operating characteristic analysis based on AR. Results The study included 90 patients. AR was observed in 26 patients. In this study, ''early-AR'' was defined as any AR within 2 weeks post-transplant (n = 22) and ''late-AR'' was defined as any AR after 1-month post-transplant (n = 4). For early AR, the relationship between tacrolimus TTR and the onset of AR was examined. There were no differences in the tacrolimus TTR between the early-AR group and non-AR group (35.7 +/- 22.4 vs 31.5 +/- 19.9, P = 0.416). For late-AR, the relationship with tacrolimus TTR was examined every 10 d. The tacrolimus TTR during postoperative days (POD) 21-30 and POD 31-onset was significantly lower in the late-AR group than the no-AR group (50.0 +/- 7.1 vs. 71.8 +/- 18.0 and 37.0 +/- 26.6 vs. 68.9 +/- 31.5, P < 0.05, respectively). The cutoff value of the tacrolimus TTR during POD 21-30 was estimated as 55.0. Conclusions Our findings suggest that a lower tacrolimus TTR is a predictor of late AR. A tacrolimus TTR of 55 or higher is necessary to reduce the risk of AR during this period after lung transplantation.
机译：背景 他克莫司是肺移植后免疫抑制治疗的关键药物。术后早期血液他克莫司水平可能会波动，未能将他克莫司谷水平维持在目标范围内是排斥反应的危险因素。然而，关于他克莫司谷水平（他克莫司 TTR）的治疗范围时间 （TTR） 与临床结果之间关系的信息很少。本研究旨在评估他克莫司 TTR 与肺移植后前三个月内急性排斥反应 （AR） 之间的关联。方法 本研究纳入了在单一中心接受肺移植的患者。目标他克莫司谷水平为 10-15 ng/mL，使用 Rosendaal 方法计算他克莫司 TTR。通过基于AR的受试者工作特征分析估计他克莫司TTR的临界值。 结果 纳入90例患者。在 26 例患者中观察到 AR。在这项研究中，“早期 AR”被定义为移植后 2 周内的任何 AR （n = 22），“晚期 AR”被定义为移植后 1 个月后的任何 AR （n = 4）。对于早期 AR，研究了他克莫司 TTR 与 AR 发作之间的关系。早期AR组和非AR组的他克莫司TTR没有差异（35.7 +/- 22.4 vs 31.5 +/- 19.9%，P = 0.416）。对于晚期 AR，每 10 天检查一次与他克莫司 TTR 的关系。术后第21-30天（POD）和POD31发病的他克莫司TTR显著低于无AR组（分别为50.0 +/- 7.1 vs. 71.8 +/- 18.0%和37.0 +/- 26.6 vs. 68.9 +/- 31.5%，P < 0.05）。POD 21-30 期间他克莫司 TTR 的临界值估计为 55.0%。结论 我们的研究结果表明，较低的他克莫司 TTR 是晚期 AR 的预测因子。在肺移植后的这段时间内，他克莫司 TTR 为 55% 或更高，以降低 AR 的风险。

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