"Minimizing Tacrolimus" Strategy For Long-term Tactical Right After Liver Transplantation

PurposeTo investigate the "minimizing tacrolimus" strategy for long-term tactical right after liver transplantation.MethodsWe conducted an observational study comprising319patients who received LT between Jan2009to Dec2011in First Affiliated Hospital, Zhejiang University. Finally, with the logical elimination,235patients were included in the study. The relationship between early TAC exposure and survival period was analyzed by Kaplan Meier curves. Adverse effects related to TAC were evaluated by Chi square test. Routine monitoring of tacrolimus concentration in blood (TC) was performed by using the PRO-TracTM Ⅱ Tacrolimus Elisa Kit (Diasorin, USA). Additionally, serum ALT, AST, Alb, WBC, Bilirubin, Urea and Creatinine were also measured. ResultsOut of235subjects enrolled in the study,124(52.8%) subjects experienced adverse effect of TAC. Evaluating TC mean groups, the survival rate of TC mean<5ng/ml was obviously lower than other groups (P<0.05) while TC mean5-7ng/ml,7-10ng/ml and10-15ng/ml groups were comparable to each other, but adverse effect of TAC presented in all four groups was not statistically valuable (P>0.05). Comparing standard deviation (SD) of TC among the groups, survival rate of SD2-4group was obviously higher than other groups (P<0.05) while in SD<2and SD>4groups were not statistically different (P=0.286), adverse effect experienced in all three groups was not statistically significant (P>0.05). In cox regression, the patient showed better outcomes in case of male gender, primary diagnosis as benign disease, TC mean>5ng/ml and TC SD2-4.ConclusionWe combined mean and SD to evaluate beneficial early exposure of TC and revealed the "minimizing tacrolimus" strategy where TC mean5-10ng/ml and SD2-4as the optimal range during the first4weeks after orthotopic liver transplant (OLT) for long-term survival and preventing its related side effects.