Tacrolimus dose prediction during the perioperative period among Thai kidney transplant recipients

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Arissara Lerkchavee
Natavudh Townamchai


Background: Tacrolimus (TAC) is the cornerstone of immunosuppressive drug therapy after kidney transplant (KT). Achieving target TAC concentrations as soon as possible is crucial, especially during the early posttransplant period. Too low or too high tacrolimus exposure can lead to unfavorable complications. This study aimed to develop an equation to predict achieving target tacrolimus dose used at days 3-5 of post KT surgery.

Methods: A retrospective cohort study was conducted at King Chulalongkorn Memorial Hospital, Thailand. We divided subjects in 2 cohorts; the first developmental cohort was KT recipients from 2015-2018 and the second was a validation cohort from 2019-2020. The dose prediction model was developed based on exponential function due to nonlinear association between target TAC dose (mg/kg) and 12-hour level after the first dose (TAC C12).

Results: A total of 206 KT recipients was enrolled, 140 KT recipients in the developmental cohort and 99 (70.7%) deceased donor KT recipients. Mean TAC dose used days 3-5 post-transplant was 5.8 ± 1.9 mg/day in the developmental cohort the same as the TAC dose used in the validation cohort 5.8 ± 2.1 mg/day. We calculated the dose of TAC for achieving an average therapeutic level of 8.5 ng/mL days 3-5 post-transplant involving the equations below.

Adjusted TAC dose days 3-5 (mg/kg) = 0.2588691* TAC C12(-0.47730647) * Hemoglobin (-0.03101605)

The R2 of the developmental cohort was 0.3125 and that of the validation cohort was 0.2929. Mean absolute error (MAE) of TAC dose was 0.0392191 mg/kg.

Conclusion: The TAC dose prediction equation developed from clinical factors, could guide nephrologists to adjust TAC dose during perioperative KT among individual patients and this optimization could reduce both TAC toxicity and KT rejection rates.


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Lerkchavee, A., & Townamchai, N. (2022). Tacrolimus dose prediction during the perioperative period among Thai kidney transplant recipients. Journal of the Nephrology Society of Thailand, 28(2), 60–67. Retrieved from https://he01.tci-thaijo.org/index.php/JNST/article/view/258806
Original Article


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