Özet:

Long-effective Takrolimus use in adult kidney transplant patients, long-term effect on kidney and patient resilience, single-centric experience Target: Takrolimus is one of the most important immune suppressant agents used in organ transplant patients. There is information that the long-effective preparation of tacrolimus reduces polypharmacy and keeps the blood level of tacrolimus more stable. We also intended to investigate the effects of renal function change and patient survival in patients with long-effective tacrolimus and kidney transplant followed for at least 1 year in our organ transplant unit. MATERIAL METHOD: In our single-centric retrospective observation study, 934 patient files were scanned in our unit with a kidney transplant. 45 patients followed by a period of at least 1 year of conversion from long-release to long-release to long-release to long-release to long-release to long-release. Together with demographic data of patients, the moment of change creatins, the post-change tracking periods, the values of the last creatins and the patient's duration were evaluated. The level of Delta creatine was calculated by the patient's extraction of the patient's change moment level of creatine from the patient's last creatine. The average age of 45 patients in the study was 47.7 ± 13.6 years (minimum 19 - max 70). 29 of the patients (64.4 percent) were male and 16 (35 percent) female. 5 of the patients (11.1%) were over 65 years old. When patients were evaluated primary kidney diseases, 5 (11.1%) were diabetic kidney disease, 5 (11.1%) primary glomerulonefritis, 4 (8.9%) hypertensive nefrosclerosis, 4 (8.9%) autozomac dominant polycystic kidney disease, 5 were obstructive nephropathy-related kidney insufficiency. 10 (22.2%) were due to other causes and 12 of the patients (26.7%) had primary kidney disease unknown. Three of the patients (6.7%) were second transplant. Prior to conversion, 39 patients (86) used tacrolimus + Mikofenolate Mofetil/Mikofenolate Sodium (MMF/MYF) + prednisolone while 3 patients (6.7%) used tacrolimus + Azatiopurin + perdnisolone. 2 patients (4.4%) were taking Takrolimus + Everolimus + prednisolone, and 1 patient (2.2%) was taking Takrolimus + MMF. In 8 of the patients (17.8%) the long-effective tacrolimus was initiated in the 3rd day of the pre-transplant as denovo. In 2 patients (4.4%) the first week of posttransplant was long-effective tacrolimusa conversion. Of the remaining 35 patients, 29 u tacrolimus were caused by a long-effective tacrolimus exchange due to a variation in blood levels, 3 patients were caused by polypharmacy, and 3 patients were caused by a long-effective tacrolimus exchange due to a variation in tacrolimus during the period of viral infection. The patient's change moment creatin average was 1.23 ± 0.34 mg/dl (min 0.60, max 1.90). The average time to change was 39 (IQR 22-77, min 3 months, max 190 months). The follow-up period of post-changing patients was an average of 44.8 ± 14.6 months (min 14 , max 74 months). The patient's final tracking creatin average was 1.48 ± 0.49 mg/dl (min 0.7, max 3.7) . The patient’s delta creatine average was 0.10 (IQR was 0.05 - 0.40 mg/dl). In 2 of the patients (4.4%) followed DSA (Donor-specific antibodies) and developed antibodies rejection. 5 of the 45 followed patients (11.1%) were ex, while the tracking of 40 patients in our unit is still ongoing. Three (60%) of ex patients were 65 years old and two were under 65 years old. The mortality rate was higher in elderly patients (p <0,001). The most important reason for the long-release tacrolimus conversion in our unit was the blood levels of tacrolimus variation. There was no significant change in the levels of creatine in patients followed for an average of 4 years after the change. The post-conversion mortality was higher especially in patients over the age of 65. Long-effective tacrolimus use has not caused a significant change in the levels of creatine. Keywords: Long effective takrolimus, renal transplantation, patient and graft survival

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