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Intra‐patient variability in tacrolimus exposure in pediatric liver transplant recipients : evolution, risk factors, and impact on patient outcomes

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Abstract
Background: This study aims to investigate the evolution and factors associated with TAC IPV and its impact on patient outcomes in pediatric LT recipients. Methods: This is a retrospective study including 41 children. The TAC IPV was expressed as the coefficient of variation and was calculated for years 1-5 following LT. The number of missed clinic appointments was used as a surrogate marker for therapy adherence. Results: We identified a decrease in the TAC IPV during the first 3 years after LT (P < 0.01). Serum albumin in the first year (P = 0.03), hematocrit (P = 0.02) and total bilirubin (P = 0.04) in the third year, and therapy adherence (P < 0.01) in the fifth year were associated with TAC IPV. High TAC IPV was associated with biopsy-proven acute allograft rejection (P = 0.04) and the need for biopsy during the first year (P = 0.02). There was a borderline association between TAC IPV and donor-specific antibodies (P = 0.08) and CMV viremia (P = 0.07). High TAC IPV was a predictor of need for liver biopsy and AR with an odds ratio of 1.04 (95% CI 1.0-1.1; P = 0.03) and 1.04 (95% CI 1.0-1.1; P = 0.05), respectively. Conclusions: Our results highlight the impact of biological factors on TAC IPV during the early LT follow-up and later also therapy adherence. High TAC IPV may be associated with adverse patient outcomes.
Keywords
Pediatrics, Perinatology, and Child Health, Transplantation, BLOOD-LEVELS, EVALUATING NONADHERENCE, GRAFT LOSS, HEMATOCRIT, PHARMACOKINETICS, REJECTION, MEDICATIONS, CLEARANCE, ADHERENCE, LEVEL

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MLA
Defrancq, Charlotte, et al. “Intra‐patient Variability in Tacrolimus Exposure in Pediatric Liver Transplant Recipients : Evolution, Risk Factors, and Impact on Patient Outcomes.” PEDIATRIC TRANSPLANTATION, vol. 23, no. 3, 2019, doi:10.1111/petr.13388.
APA
Defrancq, C., De Wilde, N., Raes, A., Van Biervliet, S., Vande Velde, S., Van Winckel, M., … Prytula-Ebels, A. (2019). Intra‐patient variability in tacrolimus exposure in pediatric liver transplant recipients : evolution, risk factors, and impact on patient outcomes. PEDIATRIC TRANSPLANTATION, 23(3). https://doi.org/10.1111/petr.13388
Chicago author-date
Defrancq, Charlotte, Nika De Wilde, Ann Raes, Stephanie Van Biervliet, Saskia Vande Velde, Myriam Van Winckel, Ruth De Bruyne, and Agnieszka Prytula-Ebels. 2019. “Intra‐patient Variability in Tacrolimus Exposure in Pediatric Liver Transplant Recipients : Evolution, Risk Factors, and Impact on Patient Outcomes.” PEDIATRIC TRANSPLANTATION 23 (3). https://doi.org/10.1111/petr.13388.
Chicago author-date (all authors)
Defrancq, Charlotte, Nika De Wilde, Ann Raes, Stephanie Van Biervliet, Saskia Vande Velde, Myriam Van Winckel, Ruth De Bruyne, and Agnieszka Prytula-Ebels. 2019. “Intra‐patient Variability in Tacrolimus Exposure in Pediatric Liver Transplant Recipients : Evolution, Risk Factors, and Impact on Patient Outcomes.” PEDIATRIC TRANSPLANTATION 23 (3). doi:10.1111/petr.13388.
Vancouver
1.
Defrancq C, De Wilde N, Raes A, Van Biervliet S, Vande Velde S, Van Winckel M, et al. Intra‐patient variability in tacrolimus exposure in pediatric liver transplant recipients : evolution, risk factors, and impact on patient outcomes. PEDIATRIC TRANSPLANTATION. 2019;23(3).
IEEE
[1]
C. Defrancq et al., “Intra‐patient variability in tacrolimus exposure in pediatric liver transplant recipients : evolution, risk factors, and impact on patient outcomes,” PEDIATRIC TRANSPLANTATION, vol. 23, no. 3, 2019.
@article{8611624,
  abstract     = {Background: This study aims to investigate the evolution and factors associated with TAC IPV and its impact on patient outcomes in pediatric LT recipients.
Methods: This is a retrospective study including 41 children. The TAC IPV was expressed as the coefficient of variation and was calculated for years 1-5 following LT. The number of missed clinic appointments was used as a surrogate marker for therapy adherence.
Results: We identified a decrease in the TAC IPV during the first 3 years after LT (P < 0.01). Serum albumin in the first year (P = 0.03), hematocrit (P = 0.02) and total bilirubin (P = 0.04) in the third year, and therapy adherence (P < 0.01) in the fifth year were associated with TAC IPV. High TAC IPV was associated with biopsy-proven acute allograft rejection (P = 0.04) and the need for biopsy during the first year (P = 0.02). There was a borderline association between TAC IPV and donor-specific antibodies (P = 0.08) and CMV viremia (P = 0.07). High TAC IPV was a predictor of need for liver biopsy and AR with an odds ratio of 1.04 (95% CI 1.0-1.1; P = 0.03) and 1.04 (95% CI 1.0-1.1; P = 0.05), respectively.
Conclusions: Our results highlight the impact of biological factors on TAC IPV during the early LT follow-up and later also therapy adherence. High TAC IPV may be associated with adverse patient outcomes.},
  articleno    = {e13388},
  author       = {Defrancq, Charlotte and De Wilde, Nika and Raes, Ann and Van Biervliet, Stephanie and Vande Velde, Saskia and Van Winckel, Myriam and De Bruyne, Ruth and Prytula-Ebels, Agnieszka},
  issn         = {1397-3142},
  journal      = {PEDIATRIC TRANSPLANTATION},
  keywords     = {Pediatrics,Perinatology,and Child Health,Transplantation,BLOOD-LEVELS,EVALUATING NONADHERENCE,GRAFT LOSS,HEMATOCRIT,PHARMACOKINETICS,REJECTION,MEDICATIONS,CLEARANCE,ADHERENCE,LEVEL},
  language     = {eng},
  number       = {3},
  pages        = {7},
  title        = {Intra‐patient variability in tacrolimus exposure in pediatric liver transplant recipients : evolution, risk factors, and impact on patient outcomes},
  url          = {http://dx.doi.org/10.1111/petr.13388},
  volume       = {23},
  year         = {2019},
}

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