Switching from Prograf® to Advagraf® in Stable Kidney Transplant Recipients-Do Asians Differ?

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IntroductionOnce-daily tacrolimus (Advagraf®), touted to improve treatment adherence, is increasingly being used to replace twice-daily tacrolimus (Prograf®) in kidney transplant recipients (KTR). Conversion is usually done using a dose ratio of 1:1, but there is suggestion that ethnicity influences dosage adjustment and Asian patients may require higher doses to achieve target trough concentrations.ObjectiveTo determine the safety and difference in daily tacrolimus dosage following conversion from Prograf® to Advagraf® in a cohort of Malaysian KTR.MethodsThis retrospective analysis was performed on all KTR in our centre who had undergone renal transplantation from January 2000 to December 2016 and were converted from Prograf® to Advagraf®. Eligible subjects were identified from the hospital renal transplant database and clinical and laboratory data were extracted from patients’ electronic medical records in the total hospital information system (Cerner Millennium).ResultsFrom January 2000 till December 2016, a total of 18 KTR underwent conversion from Prograf® to Advagraf® on a 1mg: 1mg basis. Ten (55.6%) KTR were male and 7 (38.9%) were diabetics. Nine (50.0%) received their kidneys from living donors. At time of conversion, the mean age of recipients was 46.55±15.45years and the mean duration post transplantation was 96.94±46.86 months.The mean tacrolimus daily dose was 2.42±1.43 mg/day at conversion and increased significantly to 3.01±1.98 mg/day six months after conversion (p=0.013). There was no significant change in mean tacrolimus trough levels before and after conversion.There was no difference in allograft function before and after conversion [eGFR was 57.48 ± 24.79mls/min/1.73m2 pre conversion vs 57.08 ± 26.15mls/min/1.73m2 at 6 months post conversion (p=0.846)] and no allograft rejection was reported.ConclusionSwitching from twice-daily tacrolimus (Prograf®) to once-daily formulation (Advagraf®) in our patients who are of Asian ethnicity is safe but associated with nearly 25% increase in daily tacrolimus dosage, which is significantly higher.However, this study is limited by its small sample size and a larger multi-centre study will be required to confirm this finding.

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