ArticleClinical transplantation2025
Decreasing the Risk of Early Sub-Therapeutic Tacrolimus Troughs on Short-Term Outcomes in Low-Moderate Risk Kidney Transplant Recipients Receiving Rabbit Anti-Thymocyte Globulin Induction.
Article in Clinical transplantation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionOutcomes are poor in kidney transplant (KTx) recipients with sub-therapeutic tacrolimus troughs. It is unknown if rabbit anti-thymocyte globulin (rATG) induction delays the deleterious impact of early sub-therapeutic tacrolimus troughs. The study aims compared short-term graft outcomes of KTx recipients stratified by tacrolimus troughs at the time of discharge from index admission.
methodsSingle-center retrospective cohort study compared adult KTx recipients with sub-therapeutic versus therapeutic discharge tacrolimus troughs (defined as < vs. ≥ 8 ng/mL). Successful primary/secondary KTx between 10/2017 and 12/2019, who received rATG induction and tacrolimus-based immunosuppression and had an index admission length of stay ≤5 days were included. The primary composite outcome analyzed the 3-month risk of rejection, graft loss, or de novo donor-specific antibodies (dnDSA). Cox regression analysis assessed the association of early sub-therapeutic tacrolimus troughs on short-term graft outcomes.
resultsAmong 411 recipients included, 335 (81.5%) were discharged with a tacrolimus trough <8 ng/mL versus 76 (18%) ≥8 ng/mL. Our population consisted of 30% black/non-Hispanic, 10% with a history of previous KTx, 60% deceased donors, and low cPRA (median 0%), which was in the low immunological risk range. No significant difference was identified in the primary outcome (13.4% vs. 9.2%, p = 0.44). Cox regression analysis identified no association between sub-therapeutic tacrolimus troughs at discharge and the primary outcome.
conclusionKTx recipients receiving rATG induction, discharged with sub-therapeutic tacrolimus troughs (<8 ng/mL) have comparable short-term graft outcomes versus those discharged with therapeutic troughs (≥8 ng/mL). This suggests that delaying discharge to reach therapeutic troughs is not necessary.
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