Journal of hepato-biliary-pancreatic sciences · 2025
Association Between Time-In-Therapeutic Range of Calcineurin Inhibitor Trough Level and Short-Term Outcomes of Recipients After Adult Living-Donor Liver Transplantation.
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Takahashi Ryugen, Akamatsu Nobuhisa, Saruta Yuya, Nakamura Mei, Nishioka Yujiro, Mihara Yuichiro, Ichida Akihiko, Takamoto Takeshi, Kawaguchi Yoshikuni, Hasegawa Kiyoshi
Аннотация
BACKGROUND: Time-in therapeutic range (TTR) is defined as the time a drug concentration remains within the therapeutic range. To explore the optimal management of calcineurin inhibitor (CNI), we investigated how TTR percentage (TTR%) in two different CNI protocols relates to short-term outcomes after living-donor liver transplantation (LDLT).
METHODS: TTR% was estimated for two different protocols in 352 adult LDLT recipients over 90 days in this retrospective, single-center study. Short-term outcomes were compared among the TTR% groups in each protocol.
RESULTS: Higher TTR% was associated with better acute rejection-free survival: 96.2%, 86.1%, 74.7%, and 38.9% for TTR% ≥ 60%, ≥ 50%-< 60%, ≥ 40%-< 50%, and < 40%, in the low-target protocol, respectively (p < 0.001, log-rank test); 73.7%, 74.3%, 63.6%, and 48.3%, in the high-target protocol, respectively (p = 0.003). The incidence of adverse events was similar among TTR% groups in each protocol. Multivariate analysis revealed higher TTR% was protective for rejection-free survival, and this trend was particularly pronounced in the low-target protocol.
CONCLUSIONS: High TTR%, reflecting well-controlled CNI levels, was associated with better outcomes after LDLT. The outcome of high TTR% in low-target protocol seems better, but further prospective validation is warranted.
METHODS: TTR% was estimated for two different protocols in 352 adult LDLT recipients over 90 days in this retrospective, single-center study. Short-term outcomes were compared among the TTR% groups in each protocol.
RESULTS: Higher TTR% was associated with better acute rejection-free survival: 96.2%, 86.1%, 74.7%, and 38.9% for TTR% ≥ 60%, ≥ 50%-< 60%, ≥ 40%-< 50%, and < 40%, in the low-target protocol, respectively (p < 0.001, log-rank test); 73.7%, 74.3%, 63.6%, and 48.3%, in the high-target protocol, respectively (p = 0.003). The incidence of adverse events was similar among TTR% groups in each protocol. Multivariate analysis revealed higher TTR% was protective for rejection-free survival, and this trend was particularly pronounced in the low-target protocol.
CONCLUSIONS: High TTR%, reflecting well-controlled CNI levels, was associated with better outcomes after LDLT. The outcome of high TTR% in low-target protocol seems better, but further prospective validation is warranted.