Clinical transplantation · 2026
High Tacrolimus Intra-Patient Variability and Adverse Outcomes in Cardiac Transplant Recipients: A Single-Center Study in China.
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Wang Zhenzhen, Zheng Hua, Zhang Mian, Wang Yibo, Liu Yunfei, Zeng Dong, Zheng Hongxiang, Yang Bin, Guo Lin
Аннотация
PURPOSE: To evaluate the association between tacrolimus intra-patient variability (IPV) and the prognosis of cardiac transplant recipients.
METHODS: Tacrolimus trough concentrations (C0) from cardiac transplant recipients were collected during the postoperative months 3-6. Dose-adjusted IPV values were calculated, and recipients were divided into high-IPV and low-IPV groups. The composite endpoint was defined as the occurrence of any one of the following: infection, rejection, or mortality.
RESULTS: A total of 202 recipients were included. The incidence of infections was significantly higher in the high-IPV group (34.8% vs. 21.1%, χ2 = 4.480, p = 0.034). The risk of infection and composite endpoint occurrence was approximately 2.2 and 2.1 times higher, respectively, in the high-IPV group than in the low-IPV group, with hazard ratios (HR) and 95% CIs of 2.215 (1.175-3.842) and 2.061 (1.258-3.378). No significant differences were observed between the two groups in terms of rejection or mortality (p > 0.05). Cox regression analysis revealed that the relative risk of composite endpoint occurrence in the high-IPV group was 2.024 times higher than in the low-IPV group. The cumulative event-free survival rates for the composite endpoint differed significantly between the two groups. Log-rank testing of the survival curves yielded p = 0.004 and HR = 2.061 (95% CI: 1.258-3.378).
CONCLUSION: Cardiac transplant recipients with high tacrolimus IPV may be at increased risk of adverse events such as infections. Tacrolimus IPV, which is simple to calculate, can serve as a useful follow-up tool for predicting postoperative adverse outcomes.
METHODS: Tacrolimus trough concentrations (C0) from cardiac transplant recipients were collected during the postoperative months 3-6. Dose-adjusted IPV values were calculated, and recipients were divided into high-IPV and low-IPV groups. The composite endpoint was defined as the occurrence of any one of the following: infection, rejection, or mortality.
RESULTS: A total of 202 recipients were included. The incidence of infections was significantly higher in the high-IPV group (34.8% vs. 21.1%, χ2 = 4.480, p = 0.034). The risk of infection and composite endpoint occurrence was approximately 2.2 and 2.1 times higher, respectively, in the high-IPV group than in the low-IPV group, with hazard ratios (HR) and 95% CIs of 2.215 (1.175-3.842) and 2.061 (1.258-3.378). No significant differences were observed between the two groups in terms of rejection or mortality (p > 0.05). Cox regression analysis revealed that the relative risk of composite endpoint occurrence in the high-IPV group was 2.024 times higher than in the low-IPV group. The cumulative event-free survival rates for the composite endpoint differed significantly between the two groups. Log-rank testing of the survival curves yielded p = 0.004 and HR = 2.061 (95% CI: 1.258-3.378).
CONCLUSION: Cardiac transplant recipients with high tacrolimus IPV may be at increased risk of adverse events such as infections. Tacrolimus IPV, which is simple to calculate, can serve as a useful follow-up tool for predicting postoperative adverse outcomes.