LCPT in tacrolimus fast-metabolizing pancreas recipients compared to high-dose prolonged release tacrolimus versus non-fast metabolizers: a singlecenter experience |Biomedgrid

We compared conversion to LCPT vs high dose prolonged release (PR)-Tacrolimus (Tac) in Tac fast-versus non-fast metabolizing patients. A total of 45 pancreatic graft recipients (43 combined kidney-pancreas, two pancreas transplant alone) were retrospectively analyzed. Immunosuppression consisted of a lymphocyte depleting agent, Tac+MMF+steroids. In response to subtherapeutic Tac-levels despite incremental increase of PR-Tacdosage, 15 patients were converted to LCPT (median day 10.9; range 5-21), after being identified as Tac-fast metabolizers (group 1) by the ratio of concentration/dosage (c/d)<1.05 (median: 0.69; range 0.3 0.9). Another 15 patients with a median c/d ratio 0.22 (range 0.4–0.9) were given high dosed IR-/PR-Tac (group 2). Group 3 consisted of 15 non-fast metabolizing patients (median c/d ratio 1.75; range 1.2–3.8). At 17.2 months, all study patients are alive. In group 1, no pancreatic and renal graft was lost. In group 2, two pancreata were lost to thrombosis, in group 3 one pancreas was lost for necrotizing pancreatitis and one for thrombosis, one kidney for primary non-function. All patients with a pancreas graft in situ are insulinfree. Complications were comparable between all groups. LCPT is a promising alternative for Tac fast metabolizers in pancreatic transplantation.