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Optimal Level of Tacrolimus to Prevent Acute Graft-Versus-Host Disease
J. Kor. Soc. Health-syst. Pharm. 2020;37:444-458
Published online November 30, 2020;
© 2020 Korean Society of Health-System Pharmacists

Mi Jin Kima, Ae Ryoung Parka, Shin Yi Hwangboa and Sandy Jeong Rhieb†

Department of Pharmacy, The Catholic University of Korea, Seoul ST. Mary`s Hospital 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Koreaa
Division of Life and Pharmaceutical Sciences & College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Koreab
Correspondence to: 이정연 Tel:02-3277-3023
Received May 19, 2020; Revised July 30, 2020; Accepted October 21, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background : Graft versus host disease (GVHD) is a major adverse effect of allogeneic stem cell transplantation and acute graft versus host disease (aGVHD) occurs in 40~50% of recipients. The incidence of aGVHD is higher with unrelated transplantation of incompatible human leukocyte antigen (HLA) and tacrolimus has been shown to be an effective immunosuppressant to prevent from aGVHD. Although there are studies to compare the incidence of GVHD with target blood concentration of tacrolimus, it is hard to conclude the optimal concentration of tacrolimus because of the difference in the study population and practice settings. The aim of this study is to evaluate the optimal concentration of tacrolimus to prevent aGVHD by analyzing the related factors of aGVHD incidence and side effects of tacrolimus.
Methods : This study was retrospectively conducted on Korean adult patients who received tacrolimus after hematopoietic stem cell transplantation from July 2014 to June 2015. This study analyzed the concentration of tacrolimus according to the incidence of aGVHD and its related factors, and side effects of tacrolimus in each range of concentrations.
Results : Among the 115 patients aGVHD occurred in 90 (78.3%) patients and the mean concentration of tacrolimus within 100 days post transplantation was 8.14 ng/ml in aGVHD group and 9.66 ng/ml in non aGVHD group (p=0.015). Mean concentration at 3 week post transplantation was 8.87 ng/ml in grade II-IV aGVHD and 10.09 ng/ml in grade 0-I aGVHD (p=0.048). The incidence of aGVHD was significantly lower with the mean concentration of tacrolimus within 100 days of post transplantation of ≥12 ng/ml group than others. In the analysis of side effect of tacrolimus, hyperkalemia was higher in ≥12 ng/ml group than <8 ng/ml group (p=0.02).
Conclusion : In our study, the mean concentration of tacrolimus of 12 ng/ml within 100 days after transplantation tends to lower the incidence of aGVHD.
Keywords : Acute graft-versus-host disease (aGVHD), Stem cell transplantation (SCT), Tacrolimus

November 2020, 37 (4)