Korean J Transplant.  2020 Dec;34(Supple 1):S11. 10.4285/ATW2020.OR-1184.

Safety and efficacy of conversion to once-daily tacrolimus from twice-daily tacrolimus in pediatric liver transplant recipients

  • 1Department of Surgery, Samsung Medical Center, Seoul, Korea
  • 2Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Seoul, Korea
  • 3Division of Transplantation, Department of Surgery, Samsung Medical Center, Seoul, Korea
  • 4Division of Transplantation, Department of Surgery, Vinmec Healthcare System, Hanoi, Vietnam


Nonadherence of immunosuppression is the most common cause of late acute rejection in pediatric liver recipients. Simpler dosing regimens promote better compliance behavior, especially in pediatric patients.
We screened 182 pediatric liver transplant (LT) recipients converted from twice daily tacrolimus (TD-TAC, Prograf) to once daily tacrolimus (OD-TAC, Advagraf) between February 2011 and September 2019. Tacrolimus trough levels, doses of tacrolimus, and liver function tests (LFT) were recorded in 3 months intervals 18 months before and after conversion.
One hundred and seventy-nine patients were converted to OD-TAC and followed for 18 months. One hundred and fifty-four out of 179 patients (86.0%) converted to OD-TAC and were uneventful during follow-up. Twenty-one patients had LFT elevation above 80 U/L. These patients’ LFT normalized after OD-TAC dose adjustment (n=12) or switching back to TD-TAC (n=9). Four patients had biopsy-proven acute rejection within 6 months after conversion, and all of which were successfully treated with steroid pulse. Currently, 166 out of 179 patients (92.7%) remain on OD-TAC and 13 patients (7.3%) were switched back to TD-TAC. Mean tacrolimus trough level significantly decreased at 3 months (3.14±1.9 ng/mL) following conversion compared to pre-conversion level (3.69±1.98 ng/mL). Mean tacrolimus trough levels remained unchanged from 3 to 12 months following conversion. Mean daily tacrolimus dosage was increased from pre-conversion dosage (1.60±1.29 mg) to initial conversion dose (1.76±1.31 mg) and once again at 3 months (1.80±1.23 mg) following conversion. Tacrolimus dosage remained unchanged from 3 to 12 months. Percent coefficient of variation of tacrolimus trough levels was significantly decreased from 32.5±16.4 to 27.5±15.6 ng/ mL after conversion to OD-TAC, reflecting the decrease in variation of tacrolimus trough levels following conversion.
Conversion to OD-TAC in pediatric LT recipients with stable graft function is safe and effective.

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