A tacrolimus trough or IV infusion level of 10 – 15 ng/ml was targeted for preventing lung transplant rejection. We describe the relationship of tacrolimus levels, 10 ng/ml on day of acute lung rejection on transbronchial lung biopsy (TBLB) in the first year, first 90 days and day 91 through the first year post transplant.
All patients who received tacrolimus, had TBLBs performed from 1996 through March 2003 were included. We identified all TBLB results performed with tacrolimus trough or IV infusion levels 10 ng/ml. Statistical tests included Chi-Square and Fisher Exact analysis (p < 0.05).
134 lung transplants received tacrolimus with TBLBs. In the < 90 days post transplant group, 51 (34.2%) TBLBs were positive for rejection. 37 (24.8%) of the 149 TBLBs were associated with tacrolimus levels 90 days to 1 year post transplant group, 27 (10.3%) TBLBs were positive for rejection. 62 (31.6%) of the 196 TBLBs were associated with tacrolimus levels 10 ng/ml (p = 0.0484). TBLBs rejection was reduced at day 91 to 1 year with tacrolimus levels > 10 ng/ml (p 10 ng/ml (p < 0.0008).CONCLUSIONS: We conclude that there is greater risk for lung rejection in the first year post transplant if the tacrolimus trough or IV infusion level is less than 10 ng/ml. This effect is most significant after the first 90 days post transplant, suggesting the importance of tacrolimus levels at this time. However, other factors may be important in predicting early rejection.
Obtaining tacrolimus levels > 10 ng/ml are important in preventing lung rejection in the first year post transplant.
M.T. Haug, None.