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BioMed Research International
Volume 2018, Article ID 4573452, 9 pages
Research Article

Which Kidney Transplant Recipients Can Benefit from the Initial Tacrolimus Dose Reduction?

1Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
2Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
3Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, Katowice, Poland

Correspondence should be addressed to Aureliusz Kolonko;

Received 18 July 2017; Accepted 1 January 2018; Published 30 January 2018

Academic Editor: Takahisa Gono

Copyright © 2018 Kinga Krzyżowska et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Observational data suggest that the fixed initial recommended tacrolimus (Tc) dosing (0.2 mg/kg/day) results in supratherapeutic drug levels in some patients during the early posttransplant period. The aim of the study was to analyze a wide panel of patient-related factors and their interactions which increase the risk for first Tc blood level > 15 ng/ml. Materials and Methods. We performed a retrospective analysis of 488 consecutive adult kidney transplant recipients who were initially treated with triple immunosuppressive regimen containing tacrolimus twice daily. The analysis included the first assessment of Tc trough blood levels and several demographic, anthropometric, laboratory, and comedication data. Results. The multiple logistic regression analysis showed that age > 55 years, BMI > 24.6 kg/m2, blood hemoglobin concentration > 9.5 g/dl, and the presence of anti-HCV antibodies independently increased the risk for first Tc level > 15 ng/ml. The relative risk (RR) for first tacrolimus level > 15 ng/ml was 1.88 (95% CI 1.35–2.64, ) for patients with one risk factor and 2.81 (2.02–3.89, ) for patients with two risk factors. Conclusions. Initial tacrolimus dose reduction should be considered in older, overweight, or obese kidney transplant recipients and in subjects with anti-HCV antibodies. Moreover, dose reduction of tacrolimus is especially important in patients with coexisting multiple risk factors.