ArticleEuropean journal of clinical pharmacology2017
High tacrolimus blood concentrations early after lung transplantation and the risk of kidney injury.
Article in European journal of clinical pharmacology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 1 of them a synthesis that pooled it.
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Who cites it
45 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Therapeutic Drug Monitoring Strategies for Envarsus in De Novo Kidney Transplant Patients Using Population Modelling and Simulations.Advances in therapy · 2021Trial
- Unbound Plasma, Total Plasma, and Whole-Blood Tacrolimus Pharmacokinetics Early After Thoracic Organ Transplantation.Clinical pharmacokinetics · 2020Trial
- Impact of Azole Antifungals on the Conversion Ratio of Immediate-release Tacrolimus to LCP-Tacrolimus Tablets in Non-kidney Solid Organ Transplant Recipients.Transplantation direct · 2026Article
- Supratherapeutic drug concentration triggers: A novel data-driven approach to assess their value for medication safety surveillance in intensive care.British journal of clinical pharmacology · 2026Article
- Population Pharmacokinetic/Pharmacodynamic Model of the Impact of Cumulative Tacrolimus Exposure on Kidney Function After Liver Transplant.Therapeutic drug monitoring · 2026Article
- Kidney allograft outcomes in combined kidney with other solid organ transplantation.World journal of transplantation · 2026Review
- Early major adverse kidney events after lung transplantation: risk of chronic kidney disease and prognostic impact.General thoracic and cardiovascular surgery · 2026Article
- Kidney adverse events associated with calcineurin inhibitors: a real-world study based on the FAERS database and network pharmacology.Frontiers in medicine · 2026Article
- A multifactorial approach to tacrolimus therapeutic drug monitoring in complex liver transplantation: a case report.Frontiers in medicine · 2026Article
- Population pharmacokinetic characteristics of tacrolimus in Chinese lung transplant recipients and optimisation of dosing regimen during the early post-transplantation phase.European journal of clinical pharmacology · 2025Article
- Tacrolimus overdosing in lung transplant recipients: clinical manifestations and management.Journal of thoracic disease · 2025Article
- Renal Outcomes After Lung or Combined Heart-Lung Transplantation in Pulmonary Hypertension.Pulmonary circulation · 2025Article
- Acute kidney injury after lung transplantation, incidence, risk factors, and effects: A Swedish nationwide study.Acta anaesthesiologica Scandinavica · 2025Article
- Chronic Kidney Disease After Lung Transplantation in Spain: A Retrospective Single-Center Analysis.Journal of clinical medicine · 2025Article
- Tacrolimus Pharmacotherapy: Infectious Complications and Toxicity in Organ Transplant Recipients; An Updated Review.Current drug research reviews · 2025Review
- Tacrolimus Variability and Clinical Outcomes in the Early Post-lung Transplantation Period: Oral Versus Continuous Intravenous Administration.Clinical pharmacokinetics · 2024Article
- Weight,Current pharmaceutical design · 2024Article
- Calcineurin inhibitors' impact on cardiovascular and renal function, a descriptive study in lung transplant recipients from the North of Spain.Scientific reports · 2022Review
- Cell-Free Hemoglobin in Acute Kidney Injury after Lung Transplantation and Experimental Renal Ischemia/Reperfusion.International journal of molecular sciences · 2022Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeLung transplant recipients often develop acute kidney injury (AKI) evolving into chronic kidney disease (CKD). The immunosuppressant tacrolimus might be associated with the emergence of AKI. We analyzed the development and recovery of kidney injury after lung transplantation and related AKI to whole-blood tacrolimus trough concentrations and other factors causing kidney injury.
methodsWe retrospectively studied kidney injury in 186 lung-transplantation patients at the UMC Utrecht between 2001 and 2011. Kidney function and whole-blood tacrolimus trough concentrations were determined from day 1 to 14 and at 1, 3, 6, and 12 months postoperative. Systemic inflammatory response syndrome (SIRS), septic shock, and nephrotoxic medications were evaluated as covariates for AKI. We analyzed liver injury and drug-drug interactions.
resultsAKI was present in 85 (46%) patients. Tacrolimus concentrations were supra-therapeutic in 135 of 186 patients (73%). AKI in the first week after transplantation was related to supra-therapeutic tacrolimus concentrations (OR 1.55; 95% CI 1.06-2.27), ≥3 other nephrotoxic drugs (OR 1.96; 95% CI 1.02-3.77), infection (OR 2.48; 95% CI 1.31-4.70), and cystic fibrosis (OR 2.17; 95% CI 1.16-4.06). Recovery rate of AKI was lower than expected (19%), and the cumulative incidence of severe CKD at 1 year was 15%.
conclusionsAfter lung transplantation, AKI is common and often evolves into severe CKD, which is a known cause of morbidity and mortality. Supra-therapeutic whole-blood tacrolimus trough concentrations are related to the early onset of AKI. Conscientious targeting tacrolimus blood concentrations might be vital in the early phase after lung transplantation. What is known about this subject? • Lung transplant recipients often develop acute kidney injury evolving into chronic kidney disease increasing both morbidity and mortality. • To date, the pathophysiology of kidney injury after lung transplantation has not been fully elucidated. • The immunosuppressant tacrolimus is difficult to dose, especially in the unstable clinical setting, and is nephrotoxic. WHAT THIS STUDY ADDS: • For the first time, supra-therapeutic whole-blood tacrolimus trough concentrations are related to the emergence of acute kidney injury in the first days after lung transplantation. • Supra-therapeutic whole-blood tacrolimus trough concentrations often occur early after lung transplantation. • AKI after lung transplantation shows low recovery rates.
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