Background: High intra-patient variability (IPV) is increasingly recognised as a predictor of poor outcomes in solid organ recipients. The aim of this study is to assess the association of IPV of serum tacrolimus levels with demographic and clinical factors.
Methods: A retrospective chart review was undertaken from information retrieved from our electronic medical records of all patients with renal transplants and initiated on Tacrolimus based immunosuppression regimens between the year 2007 and 2017, at Inkosi Albert Luthuli Central Hospital (IALCH). Demographic and clinical characteristics were collected. The tacrolimus levels were included from the sixth month post-transplant, to approximately thirty months post-transplant. Data was analysed using the IBM SPSS Version 24 program and descriptive statistical methods and linear regression analysis were performed.
Results: Forty-one patients were suitable for analysis. Of these, twenty-three (56%) were found to have low IPV and eighteen (44%) were found to have high IPV. There is significant association of the high IPV of tacrolimus group and the rate of increase of serum creatinine. (OR:0.006; CI (0.000-0.0 12)) Furthermore, the age at transplant, ethnicity, gender sex and HLA matching were not associated with the high or low IPV groups.
Conclusion: The rate of decline of kidney function is significantly associated with the high IPV of tacrolimus group. A longer duration of observation, and larger patient cohort may be required to fully delineate the extent of the association between IPV and graft dysfunction and other clinical and demographic factors.