TY  - JOUR
A1  - Schnitzbauer, Andreas
A1  - Ayik, Ceylan
A1  - Ulrich, Frank
A1  - Bechstein, Wolf Otto
A1  - Mönch, Christian
T1  - Delayed bottom-up and amended simple method of dosing with once-daily tacrolimus application to achieve stable trough levels in liver transplantation
T2  - Annals of transplantation
N2  - Background: Tacrolimus once-daily formulation (TacOD) was introduced as an alternative to twice-daily formulations de novo. Dosing recommendations range between 0.1 to 0.2 mg/kg BW/d.
Material and Methods: Amended dosing with a simple bottom-up de novo algorithm is presented. Primary outcome measure was feasibility of establishing adequate target trough levels and avoidance of over-immunosuppression, with adequate safety and efficacy after liver transplantation (LT).
Results: TacOD was given to 101 patients. Standard steroid-free immunosuppression consisted of MMF 2 g/d, basiliximab 20 mg on day 0 and 4, and delayed bottom-up IS with TacOD starting with 1 mg/d and doubling the dosage every day until target trough levels of 5 to 8 ng/ml were reached. By day 7 after LT, all except 3 patients had received TacOD. The earliest time point of introduction was day 2. A median of 9 mg/d (range: 0 to 25 mg/d) of TacOD were necessary to establish the trough levels by day 10, which was then 5.4 ng/ml (range: 1.5 to 20 ng/ml). Incidence of adverse events (AE), in particular neurological AEs (n=3), were low. Efficacy failure (acute rejection) was low (4.9%). Renal function was stable and did not deteriorate under CNI treatment.
Conclusions: This is the first report of bottom-up, amended, and simple dosing of TacOD in LT. The algorithm is feasible, safe, and efficient, avoiding trough level peaks and top-down strategies.
KW  - Immunosuppression
KW  - Liver Transplantation
KW  - Tacrolimus
Y1  - 2015
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/53514
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-535145
SN  - 2329-0358
N1  - This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
VL  - 20
SP  - 1
EP  - 6
PB  - International Scientific Information
CY  - New York, NY
ER  -