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 22 May 2018

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Lower doses of tacrolimus for liver transplants in Hep C

Liver transplant recipients with Hepatitis-C virus require lower oral doses of tacrolimus to achieve the same blood levels compared to non-Hepatitis-C virus patients, finds the latest issue of Alimentary Pharmacology & Therapeutics.

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Hepatitis-C virus is the most common indication for liver transplantation.

Dr Trotter and colleagues from Colorado noted higher relative blood levels of tacrolimus in their patient cohort compared to patients without Hepatitis-C virus.

The research team verified this observation and determined its clinical significance.

The team performed a comparison of doses and blood levels of tacrolimus in Hepatitis-C virus and non- Hepatitis-C virus liver transplantation recipients.

The total mean tacrolimus dose in Hepatitis-C virus patients was lower by 73% during year 2
Aliomentary Pharmacology and Therapeutics

The team included patients with Hepatitis C who received a transplant from a deceased donor at the center between 1995 and 1999.

The researchers recorded tacrolimus dose and trough level, as well as mean alanine aminotransferase.

The recordings were done at monthly intervals during the first 24 months following transplantation and compared to patients without Hepatitis-C virus.

The researchers found that tacrolimus levels for Hepatitis-C virus and non-Hepatitis-C virus were not different at any of the monthly intervals, except month 9.

In addition, the team noted that the overall mean tacrolimus levels for Hepatitis-C virus and non-Hepatitis-C virus patients were not significantly different.

However, the researchers observed that the mean tacrolimus dose was significantly higher for Hepatitis-C virus patients at 12, 15, 18, 21 and 24 months.

The team found that the total mean tacrolimus dose in Hepatitis-C virus patients was lower during year 1 by 39% and by 73% during year 2.

The total difference in cost of tacrolimus for years 1 and 2 administered to Hepatitis-C virus patients was $4920.

The researchers reported that the serum alanine aminotransferase was higher in Hepatitis-C virus patients at each monthly interval except month 1.

Dr Trotter's team concluded, “Liver transplant recipients with Hepatitis-C virus require significantly lower oral doses of tacrolimus to achieve the same blood levels compared to non-Hepatitis-C virus patients.”

“This difference may result in a significant reduction in the cost of tacrolimus in Hepatitis-C virus patients.”

“The most likely explanation for these findings is decreased hepatic clearance of tacrolimus caused by mild hepatic injury from recurrent Hepatitis-C virus.”

Aliment Pharmacol & Ther 2005: 22(1): 37
27 June 2005

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