The Effect of Acute Diarrhea on Tacrolimus Trough Level Among Post Kidney Transplant Recipients at IBn Sina Hospital-Khartom-Sudan: A cross sectional study.

Abstract

Background: Diarrhoea is very common among post kidney transplant recipients which can lead to dehydration and an increase in tacrolimus (TAC) trough level. These will lead to intoxication and loss of graft function. TAC is heavily metabolized by CYP3A4 and CYP3A5 enzymes and p-glycoprotein efflux pumps located in the mature apical enterocytes of the small intestine, acute diarrhoea selectively breaches and disrupts this localized metabolic barrier, allowing a significantly higher fraction of unchanged drug to pass directly into the portal circulation, increasing systemic trough concentrations. Objective: To assess the effect of acute diarrhoea on tacrolimus trough level among post kidney transplant recipients. Methods: This is a descriptive, cross- sectional analytical hospital-based study, conducted at Ibn Sina Hospital during the period from April to June 2021. 100 post kidney transplant recipients were enrolled in the study. 50 of them had acute diarrhoea, the other 50 had no acute diarrhoea (taken as control). Results: Regarding the range of tacrolimus trough level, the findings revealed that it was above normal (target level) in 58%(n=29) with an absolute-mean of 33.3 ,SD 24.1 of those who had acute diarrhoea compared to18%(n=9) with an absolute- mean of 33.3 , SD 23.1 of the control group, which indicates significant association between elevated trough levels of tacrolimus and acute diarrhoea among post kidney transplant recipients (P < 0.05). A high level of serum creatinine was reported in 38%(n=19) with an absolute  mean of 50.0 , SD16.9 of the one who had acute diarrhoea in comparison to 18%(n=9) with an absolute mean of 50.0 , SD 45.25 of the control group, indicates significant association between elevated levels of serum creatinine and acute diarrhoea among post kidney transplant recipients (P value < 0.05). Conclusion: The study showed a significant association between acute diarrhoea and increase tacrolimus trough level among post- kidney transplant recipients. Moreover, there was a significant association between elevated levels of serum creatinine and acute diarrhoea among post- kidney transplant recipient.