Dr. Krishna Asuri

Dr. Krishna Asuri |Clyto Access

All india institute of medical sciences, India

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Title: A prospective study of the quality of life and correlation of blood levels of tacrolimus to graft function and adverse effects of tacrolimus in post-renal transplant patients

Abstract:

Introduction
There is limited data on the quality of life and symptoms of immune-suppressive therapy after transplant on Indian patients and how tacrolimus blood level correlates with graft function and its adverse effects. This study was planned to study these factors.
Materials and Methods
The study was conducted as a prospective longitudinal study conducted in the Department of Surgical Disciplines, Nephrology, Psychiatry and Ocular Pharmacology of All India Institute of Medical Sciences, New Delhi. 77 adult patients   who - underwent live renal transplant and matched the inclusion criteria from March 2012 to April 2013 were enrolled for the study. LCMS assay was used for measurement of tacrolimus blood level. Trends of all the parameters were analyzed and their correlation was done with corresponding tacrolimus blood levels. Blood for tacrolimus level was collected at Day 1, 5, 15, 30, 90 and 180 and values of serum creatinine, diabetes status, hypertensive status, lipid profile, infection occurrence and liver function tests were recorded at the same time. Patient’s quality of life was recorded pre-operatively and post-operatively at 3 months using WHO QOL BREF questionnaire. The subjective symptom occurrence was also recorded by MTSOSD-59 questionnaire at 3 months. 
Results 
The mean age of study population was 33.7 ± 10.1 years with majority (91.2%) of patients being male. The incidence of infection was highest at 48% in the 1-3 month period. Urinary tract infection was the most common infection at all time intervals and early post-transplant period was dominated by opportunistic infections. The incidence of PTDM was 13.7%. The incidence of hypertension showed a decreasing trend during the study period with patients requiring antihypertensive decreased from 93.1% immediate post-transplant to 51.5% after 6 months of transplant. There was an increase in post-transplant triglyceride levels, total cholesterol and LDL level with only HDL showing a protective trend. Liver functions did not show any derangement's during the study period. There was no significant correlation between any of the adverse effects and tacrolimus blood levels.
We found statistically significant improvement in all aspects of quality of life from pre to post-transplant stage. Excessive appetite was the most commonly experienced symptoms whereas tremor was the most distressing one. There was statistically significant increase in symptom experienced in patients whose tacrolimus blood level was above normal level for that period.
Conclusion 
In conclusion our study showed no significant correlation between blood levels of tacrolimus and graft function and also with hypertension, dyslipidemia, PTDM and incidence of post-transplant infections. There was a significant improvement of quality of life of patients following transplant in all domains. The incidence of adverse effects was significantly higher in patients who had tacrolimus blood levels higher than recommended though they were not causing significant distress. Further follow-up of these patients and inclusion of more patients is required to assess the long term graft function of these patients.

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