Once daily tacrolimus conversion in lung transplantation
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Lung transplantation (LTx) requires a calcineurin inhibitor-based immunosuppressive regimen. A once daily (QD) tacrolimus regimen was developed to increase medication adherence.

In this prospective study, stable LTx patients were consecutively converted from twice daily (BID) tacrolimus to QD tacrolimus on a 1 mg:1 mg basis. Trough level (Cmin), renal function, cholesterol, fasting glucose, potassium, and lung function were monitored six months before and up to one year after conversion. Adherence and its barriers were assessed by self-reported questionnaires BAASIS and IMAB and blood-based assays (mean Cmin and coefficient of variation (CV)).

--Researchers included 372 patients, in whom they observed a decrease in tacrolimus Cmin of 18.5% post-conversion, requiring subsequent daily dose adaptations in both cystic fibrosis and non-CF patients.

--They observed a small decrease in eGFR one-year post-conversion. No significant changes in blood creatinine, potassium, fasting glucose, cholesterol, or rate of lung function decline were observed.

--In a subgroup of 166 patients, significantly fewer patients missed doses or had irregular intake post-conversion.

-- Mean Cmin and CV, as well as the total number of barriers, also decreased significantly post-conversion.

In LTx, conversion from BID to QD tacrolimus (1 mg:1 mg) requires close monitoring of tacrolimus Cmin. QD tacrolimus after transplantation is safe with respect to renal function, metabolic parameters, and allograft function and improves LTx recipient adherence.