Laboratory markers associated with tacrolimus pharmacokinetics in kidney transplant recipients

Objective: to evaluate clinical and laboratory parameters in order to identify markers that reflect the pharmaco-kinetics of tacrolimus (Tac). Materials and methods. The study included 35 kidney transplant (KT) recipients, comprising 13 women (37.1%) and 22 men (62.9%), with a median age of 48 years [37–57]. All patients received induction immunosuppressive therapy with monoclonal anti-CD25 antibodies, followed by a maintenance regimen consisting of the calcineurin inhibitor Tac in combination with antiproliferative agents (mycophenolate or azathioprine) and corticosteroids. Tac levels were measured on postoperative days 3, 7, 14, and 30. Complete blood count and biochemical parameters, including creatinine, urea, ferritin, transferrin, C-reactive protein (CRP), sodium, potassium, chloride, calcium, total protein, and total bilirubin, were assessed preoperatively and on days 1, 3, 7, 14, and 30 following KT. Results. A statistically significant positive correlation was observed between Tac trough (C₀) levels on postoperative days 3 and 7 and total bilirubin levels on day 1 (R = 0.49, p = 0.007; R = 0.48, p = 0.009, respectively). In addition, Tac C₀ level on day 3 showed a positive correlation with total bilirubin levels measured on the same day (R = 0.52, p = 0.006). Conversely, total calcium levels on day 3 were negatively correlated with Tac C₀ levels on days 7 and 14 (R = –0.60, p = 0.031; R = –0.56, p = 0.046, respectively). Conclusion. Total bilirubin levels on postoperative day 1 are directly associated with Tac levels on days 3 and 7 following KT. Additionally, lower total calcium levels on day 3 are associated with higher Tac concentrations on days 7 and 14.

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