Experience of Tacrolimus Usage in Kidney Transplant Vietnamese Patients

Abstract

Background: Tacrolimus (Tac) has been widely used with other immunosuppressive agents to prevent graft rejection post-kidney transplantation. However, the usage of Tac has depended on experience rather than evidence-based methods. In the present study, the authors investigated the Tac usage patterns and outcomes in kidney-transplanted patients at a transplant center located in the North of Vietnam. Materials and Methods: A retrospective cross-sectional study was conducted. Patients were included if they underwent renal transplantation, received Tac as part of the immunosuppressive therapy, and had been followed up in Viet Duc Hospital during the period between February 2009 and February 2019. Excluded patients were those who did not use Tac or switched to another drug during treatment. Results: The number of followed up patients steadily decreased from 342 cases in the first six months to 281 cases in the second year, 217 in the third year, 185 in the fourth year, and 152 in the fifth year post-transplanted. Only 17 cases had a ten-year follow-up. The number of transplants from deceased donors at 9.6% was much lower than live donors at 90.4%. Three patients died through the five years of the follow-up due to causes unrelated to kidney transplantation. Ten cases were ABO-incompatible transplantations. The mean blood concentration of Tac was highest in the first six months with 10.6 ng/mL, then gradually dropped to the lowest value at 6.3 ng/mL in the fifth year. Seven cases were identified as graft rejection with no clear outcome. Conclusion: Although there were a lack of standard tests and facilities for taking care of kidney transplant patients, the intra-patient variability and Tac concentration of included patients in the author’s center were close to the international studies in developed countries in five years follow-up. Keywords: Tacrolimus; Transplantation; Kidney; Vietnam