Analysis of Factors Affecting Tacrolimus Blood Concentration Attainment in Patients with Hypertension After Renal Trans-plantation
DING Qianxue
SHANG Shenglan
YU Mengchen
LI Weiliang
TONG Ling
ZHOU Fan
CHANG Qiuyue
YU Airong
Abstract：Objective To explore the influencing factors of tacrolimus blood concentration attainment in patients with hypertension after renal transplantation,and to provide reference for the rational application of tacrolimus in patients with hypertension after renal transplantation.Methods Clinical data of patients with hypertension after renal transplanta-tion who had been treated with tacrolimus for more than 1 year in a grade A tertiary hospital in Wuhan from April 2018 to August 2023 was retrospectively collected,a total of 223 patients with 877 tacrolimus blood concentration monitoring data were collected.The patients were divided into the below target group(tacrolimus valley concentration＜4 ng/ml,n=119),met criteria group(tacrolimus valley concentration 4-8 ng/ml,n=633)and above target group(tacrolimus valley concentration＞8 ng/ml,n=125).Kruskal-Wallis H test was used to compare the indicators of the 3 groups;Logistic regression was further employed to analyze factors influencing the attainment of target tacrolimus blood concentration.Results Statistically significant differences were found in between-group comparisons of the 3 groups for factors such as age,gender,postoperative time,kilogram dose,dose-corrected valley concentration(G0/D),whether they were anemic or not,whether glucocorticoids were used in combination,total bilirubin,albumin,albumin/globulin,glomerular filtration rate,serum creatinine,urea nitro-gen,calcium ion levels,white blood cell count,neutrophil percentage,red blood cell count,hematocrit,hemoglobin con-centration,CYP3A5*3 genotype and CYP3A4*18B genotype(all P＜0.05).Logistic regression analysis showed that combining anemia(OR=1.708,95％CI:1.057-2.760),low albumin level(OR=0.924,95％CI:0.871-0.980),low kilogram dose(OR=0.004,95％CI:0.001-0.068),low hematocrit(OR=0.944,95％CI:0.908-0.982)and no combi-nation of glucocorticoids(OR=0.582,95％CI:0.406-0.833)were risk factors for substandard tacrolimus blood concen-tration in hypertensive patients after renal transplantation;high kilogram doses(OR=1.013,95％CI:1.006-1.020),short postoperative days(OR=0.880,95％CI:0.832-0.930),CYP3A5*1/*3 genotype(OR=0.374,95％CI:0.249-0.562)and CYP3A5*1*1 genotype(OR=0.441,95％CI:0.226-0.861)were risk factors for excess tacrolimus concen-tration.Conclusion When patients with hypertension after renal transplantation are treated with tacrolimus,attention should be paid to the patient's anemia,albumin level,hematocrit,kilogram dose,postoperative days and CYP3A5*3 genotype,according to the results of therapeutic drug monitoring,tacrolimus dosing regimen should be adjusted in time to improve the rate of tacrolimus blood concentration attainment in patients with hypertension after renal transplantation.
Keywords：Renal transplantationHypertensionTacrolimusBlood concentrationInfluencing factor
Publication Date：2025-02-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 126-131,137 )