The Tacrolimus Metabolism Rate and Dyslipidemia after Kidney Transplantation

• Main Authors: Gerold Thölking, Christian Schulte, Ulrich Jehn, Katharina Schütte-Nütgen, Hermann Pavenstädt, Barbara Suwelack, Stefan Reuter
• Format: Article
• Language: English
• Published: MDPI AG 2021-07-01
• Series: Journal of Clinical Medicine
• Subjects: kidney transplantation; tacrolimus; metabolism; C/D ratio; cholesterol; dyslipidemia
• Online Access: https://www.mdpi.com/2077-0383/10/14/3066

Fast tacrolimus (Tac) metabolism is associated with reduced survival rates after renal transplantation (RTx), mainly due to cardiovascular events. Because dyslipidemia is a leading cause of cardiovascular death, we hypothesized that most RTx patients do not achieve recommended target low-density lipoprotein cholesterol (LDL-C) levels (European cardiology society guidelines) and that fast Tac metabolizers have higher dyslipidemia rates. This study included RTx recipients who received initial immunosuppression with immediate-release tacrolimus (IR-Tac), mycophenolate, and prednisolone. Patients were grouped according to their Tac concentration-to-dose ratio (C/D ratio) 3 months after RTx. Dyslipidemia parameters were analyzed at RTx, 3 months, and 12 months after RTx. Statin use and renal function were documented in a 12-month follow-up, and death was documented in a 60-month follow-up. Ninety-six RTx recipients were divided into two groups: 31 fast Tac metabolizers (C/D ratio < 1.05 ng/mL·1/mg) and 65 slow metabolizers (C/D ratio ≥ 1.05 ng/mL·1/mg). There were no differences in triglyceride or cholesterol levels between groups at RTx, 3, and 12 months after RTx. A total of 93.5% of fast and 95.4% of slow metabolizers did not achieve target LDL-C levels (<i>p</i> = 0.657). Fast metabolizers developed lower renal function compared to slow metabolizers 12 months after RTx (<i>p</i> = 0.009). Fast metabolizers showed a 60 month survival rate of 96.8% compared to 94.7% in the slow metabolizer group (<i>p</i> = 0.811). As most RTx recipients do not reach recommended target LDL-C levels, individualized nutritional counseling and lipid-lowering therapy must be intensified. Fast Tac metabolism is associated with lower renal function after RTx, but does not play a significant role in dyslipidemia.