Abstract:

Objective To evaluate the association between tacrolimus intra⁃patient variability（IPV）and infection，rejection and death after heart transplantation. Methods Tacrolimus trough concentration（C0）was collected from heart transplant recipients in Zhengzhou Seventh People′s Hospital from April 2018 to October 2021 at 3 ~ 6 months after surgery. IPV was calculated after dose correction，and patients were divided into the high IPV group and the low IPV group. Results A total of 102 patients were enrolled，with an average IPV of 26.8%. Compared with the low IPV group，the proportion of recipients with at least one C0 outside the treatment target （8 to 12 ng/mL）was higher in the high tacrolimus IPV group（< 8 ng/mL：80.5% vs. 39.3%，χ2 = 16.836，P < 0.001；> 12 ng/mL：85.4% vs. 47.5%，χ2 = 15.007，P < 0.001）. The incidence of infection in the high IPV group was higher than that in the low IPV group（34.2% vs. 16.4%），with a 95% confidence interval of 17.8%（0.52% ~ 34.99%）. The difference was statistically significant（χ2 = 4.295，P = 0.038）. There was a statistically significant difference between the two groups in the combination of infection，rejection or death（18.03% vs. 39.02%，χ2 = 5.551，P = 0.018）. Conclusions The recipients with a high tacrolimus IPV may be more susceptible to infection after heart transplantation. Tacrolimus IPV is readily available and can be used as a follow⁃up tool to identify poor outcomes after transplantation.

Key words:

heart transplantation, tacrolimus, intra?patient variability, prognosis