Korean J Transplant.  2023 Nov;37(Suppl 1):S37. 10.4285/ATW2023.F-6055.

Confirmation of predictable prognosis with intrapatient variability and identification of the best intrapatient variability indicators

• Lim H
• Koh H

• KMID: 2551624
• DOI: http://doi.org/10.4285/ATW2023.F-6055

Abstract

Background
Liver transplantation (LT) is a life-saving treatment in patients with end-stage liver disease and immunosuppressants are needed to prevent immunologic adverse events. Intrapatient variability (IPV) of tacrolimus (TAC) levels is associated with poor outcomes. We aimed to investigate outcomes related to TAC IPV and find good indicators that represent IPV in pedi-atric patients.
Methods
From 2000 to 2022, pediatric LT cases were collected at Severance Hospital. Excluding retransplantation, 100 pa-tients were remained. The medical records were reviewed, and we obtained clinical factors, complications (death, rejection, infection, and biliary complication), and TAC levels for 1 year. IPV was determined medication level variability index (MLVI), co-efficient of variation (CV), and mean absolute deviation (MAD). The statistical analysis was performed using IBM SPSS ver. 26 (IBM Corp.). Figures were performed with R ver. 4.2.3 (R Foundation).
Results
The episode of death in 100 patients occurred in 11%, and it was correlated with MLVI, CV, and MAD. Area under receiver operating curve (AUROC) of IPVs was 0.697, 0.700, and 0.753 without statistical significance. In the Kaplan-Meier curve, poor survival was also confirmed in high IPV. When the patients were divided into two groups according to the cut-off level of IPV with Youden index, odds ratio of MLVI, CV and MAD were 16, 7.78 and 11.89, and hazard ratio of MLVI, CV, and MAD was 7.158, 2.847, and 4.955 with statistically significant.
Conclusions
Death is the most predictable outcome with IPVs and MAD is the most representative IPV indicator in Korean pediatric LT recipients.