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World J Gastroenterol. Aug 21, 2009; 15(31): 3931-3936
Published online Aug 21, 2009. doi: 10.3748/wjg.15.3931
Tacrolimus dosage requirements in living donor liver transplant recipients with small-for-size grafts
Fei Liu, Ya Li, Xiang Lan, Yong-Gang Wei, Bo Li, Lv-Nan Yan, Tian-Fu Wen, Ji-Chun Zhao, Ming-Qing Xu, Wen-Tao Wang, Jia-Yin Yang
Fei Liu, Xiang Lan, Yong-Gang Wei, Bo Li, Lv-Nan Yan, Tian-Fu Wen, Ji-Chun Zhao, Ming-Qing Xu, Wen-Tao Wang, Jia-Yin Yang, Department of Liver and Vascular Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Ya Li, West China School of Clinical Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Liu F and Li Y took care of the patients, designed the study, collected and analyzed the data and wrote the manuscript; Lan X, Wei YG and Li B designed the study, collected and analyzed the data and wrote the manuscript; Yan LN collected and analyzed the data, coordinated the work group and contributed to the discussion; Wen TF and Zhao JC contributed to the discussion; Xu MQ, Wang WT and Yang JY took care of the patients, collected and analyzed the data.
Correspondence to: Bo Li, MD, Department of Liver and Vascular Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. cdlibo@medmail.com.cn
Telephone: +86-28-85422476
Fax: +86-28-85423724
Received: June 5, 2009
Revised: July 20, 2009
Accepted: July 27, 2009
Published online: August 21, 2009
Abstract

AIM: To investigate the tacrolimus dosage requirements and blood concentrations in adult-to-adult right lobe living donor liver transplantation (AALDLT) recipients with small-for-size (SFS) grafts.

METHODS: During January 2007 and October 2008, a total of 54 cases of AALDLT with an observation period of 6 mo were enrolled in this study. The 54 patients were divided into two groups according to graft-recipient body weight ratio (GRBW): SFS grafts group (Group S, GRBW < 0.8%, n = 8) and non-SFS grafts group (Group N, GRBW ≥ 0.8%, n = 46). Tacrolimus 12-hour blood levels and doses were recorded during weeks 1, 2, 3 and 4 and months 2, 3, 4, 5 and 6 in group S and group N. Meanwhile, acute rejection rates, liver and renal function test results, and the number of potentially interacting medications were determined at each interval in the two groups. A comparison of tacrolimus dosage requirements and blood levels were made weekly in the first month post-surgery, and monthly from months 2 to 6.

RESULTS: There were no differences in the demographic characteristics, acute rejection rates, liver and renal function test results, or the number of potentially interacting medications administered between the two groups. The tacrolimus dosage requirements in group S were significantly lower than group N at 2 wk (2.8 ± 0.4 mg/d vs 3.6 ± 0.7 mg/d, P = 0.006), 3 wk (2.9 ± 0.7 mg/d vs 3.9 ± 0.8 mg/d, P = 0.008), 4 wk (2.9 ± 0.8 mg/d vs 3.9 ± 1.0 mg/d, P = 0.023) and 2 mo (2.8 ± 0.7 mg/d vs 3.8 ± 1.1 mg/d, P = 0.033). Tacrolimus 12-h trough concentrations were similar between the two groups at all times except for 2 wk post-transplantation, when the concentrations were significantly greater in group S recipients than in group N recipients (11.3 ± 4.8 ng/mL vs 7.0 ± 3.8 ng/mL, P = 0.026).

CONCLUSION: SFS grafts recipients have significantly decreased tacrolimus dosage requirements compared with non-SFS grafts recipients in AALDLT during the first 2 mo post-surgery.

Keywords: Blood concentration, Liver transplantation, Living donor, Small-for-size graft, Tacrolimus