Randomized controlled trial of sustained release tacrolimus vs twice daily tacrolimus in adult living donor liver transplantation

• DOI: 10.1016/j.hpb.2023.10.017
• Publication Date: 2023-10-27T00:35:32Z
• Authors: Guhan Venkatakris...; Manikandan Kathirvel; Binoj Sivasankara...; Abhijith K. Mural...; Johns S. Mathew; Christi T. Varghese; Krishnanunni Nair; Shweta Mallick; Madhu Srinivasan D; Unnikrishnan Gopa...; Dinesh Balakrishnan; Sudheer Othiyil V...; Sudhindran Surendran
• Keywords: Adult; Graft Rejection; Basiliximab; Delayed-Action Preparations; Living Donors; Humans; Kidney Transplantation; Tacrolimus; Immunosuppressive Agents; 3. Good health; Liver Transplantation

To compare the safety and efficacy of once-daily tacrolimus (ODT) versus twice-daily tacrolimus (BDT) in adult live donor liver transplantation (LDLT).In this open-labelled randomized trial, 174 adult patients undergoing LDLT were randomized into ODT or BDT, combined with basiliximab induction and mycophenolate mofetil (steroid-free regimen). Tacrolimus was started at a total dose of 1 mg and the trough level was aimed at 3-7 ng/ml. The primary endpoint was eGFR at 1,3- and 6 months post-transplant, using CKD- EPI equation. Secondary endpoints included biopsy-proven acute rejection (BPAR), metabolic complications, post-operative bilio-vascular complications and patient survival.There was no statistically significant difference in eGFR between the two groups at 6 months (ODT -96 ± 19, BDT -91 ± 21, p value-0.164). BPAR was comparable (18/84 in ODT, 19/88 in BDT, p value-0.981). For a similar dosage of tacrolimus, the median trough tacrolimus levels attained were significantly lower for ODT than BDT during the first-month post-transplant (p value-0.001). Metabolic complications due to immunosuppression, post-operative bilio-vascular complications and patient survival was similar between the two groups at 6 months.Once-daily tacrolimus has similar renal safety and efficacy as twice-daily tacrolimus when used in combination with basiliximab induction and mycophenolate in adult LDLT.