Analysis of the Effect of Donor CYP3A5 Gene Polymorphism on Early Tacrolimus Concentration and Postoperative Acute Renal Injury After Liver Transplantation

Tacrolimus is the most commonly used immunosuppressant for preventing and treating rejection after liver transplantation. However, its treatment window is narrow, the pharmacokinetic individual differences are large, routine dose according to body weight, sometimes low dose will cause graft rejection of patients, or high dose will lead to infection and liver and kidney toxicity and other adverse reactions. Moreover, the conventional drug testing can not fully reflect the efficacy of tacrolimus, and there are shortcomings of lag, experience and passivity. FK506 is metabolized primarily by cytochrome P450 member 3A5 in the liver and intestines. CYP3A5*3 is the most important factor determining the expression level of CYP3A5. This mutation can cause variable shear and produce unstable protein, so that patients carrying CYP3A5*3/*3 gene do not express CYP3A5. Acute kidney injury is a common and important complication after liver transplantation. Despite recent advances in organ preservation, surgical techniques, and immunosuppressive protocols, the incidence of AKI after orthotopic liver transplantation remains high. AKI has a significant impact on both short - and long-term prognosis of orthotopic liver transplantation recipients. Studies have shown that orthotopic liver transplantation recipients with AKI have significantly higher mortality rates in hospital, at 28 days and at 1 year after surgery than those without AKI. In this study, the relationship between donor and recipient CYP3A5 gene polymorphism and tacrolimus concentration was investigated, and the effect of donor and recipient CYP3A5 gene polymorphism and tacrolimus concentration on acute kidney injury after liver transplantation was investigated. To provide guidance for individual administration of gene-directed tacrolimus in patients, and provide basis for prevention and reduction of postoperative acute kidney injury in liver transplantation patients.

Study Overview

• Status: Active, not recruiting
• Conditions: Complete and Accurate Statistical Data of 60 Patients; CYP3A5*3 Genotypes of 60 Donors and Recipients Were Analyzed Accurately; Postoperative Tacrolimus Concentrations Were Accurately Recorded in 60 Patients; According to the Diagnosis and Grading Criteria of Acute Kidney Injury, the Cases and Grading of Postoperative Acute Kidney Injury in 60 Patients Were Counted; Scientific and Rigorous Statistical Analysis of Data
• Intervention / Treatment: Other: CYP3A5*1*、CYP3A5*1*3; Other: CYP3A5*3*3

• Study Type: Observational
• Enrollment (Estimated): 60

Contacts and Locations

Study Locations

• China
  • Shandong
    • Jinan, Shandong, China, 250013
      • The First Affiliated Hospital of Shandong First Medical University (Qianfoshan Hospital)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

60 patients receiving liver transplantation at the center of Qianfoshan Hospital in 2022.01-2023.06

Description

Inclusion Criteria:

1. Patients undergoing orthotopic liver transplantation in our center.
2. The postoperative immunosuppression regimen was tacrolimus、methylprednisolone and balipremumab for injection in all cases,and no drugs that interacted with tacrolimus were used.
3. The postoperative follow-up time was greater than 6 months and no serious rejection occurred during the follow-up period.

Exclusion Criteria:

1. Combined organ transplantation.
2. liver transplant patients on other immunosuppressive regimens.
3. Preoperative CKD or need RRT.
4. Preoperative serum creatinine (SCr) > 133 mol/L.
5. Loss of follow-ups.

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
donor/acceptor expression group	Other: CYP3A5*1*、CYP3A5*1*3; 2ml of venous blood was drawn and placed in an EDTA anticoagulant tube. Peripheral blood genomic DNA was extracted according to the instructions of the DNA extraction kit.The reaction system was prepared by polymerase chain reaction (PCR) according to the instructions of PCR amplification system. After 25g/L agarose gel electrophoresis, the bands of amplified products were observed under UV lamp. The PCR products were purified by enzymolysis. The purified product was prepared according to sequencing PCR amplification system. After 1min predenaturation at 96℃, denaturation at 96℃ for 30s, annealing at 56 ℃ for 30s and extension at 72℃ for 1 cycle. A total of 25 cycles were performed for sequencing PCR amplification. The amplified products were purified by ethanol precipitation method.
donor expression/acceptor non-expression
donor non-expression/acceptor expression
donor/acceptor non-expression group	Other: CYP3A5*3*3; 2ml of venous blood was drawn and placed in an EDTA anticoagulant tube. Peripheral blood genomic DNA was extracted according to the instructions of the DNA extraction kit.The reaction system was prepared by polymerase chain reaction (PCR) according to the instructions of PCR amplification system.After 25g/L agarose gel electrophoresis, the bands of amplified products were observed under UV lamp. The PCR products were purified by enzymolysis. The purified product was prepared according to sequencing PCR amplification system. After 1min predenaturation at 96℃, denaturation at 96℃ for 30s, annealing at 56 ℃ for 30s and extension at 72℃ for 1 cycle. A total of 25 cycles were performed for sequencing PCR amplification. The amplified products were purified by ethanol precipitation method.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fk506	Tacrolimus concentration	1-28 days postoperatively
Scr	Reflects indicators of kidney function	1-28 days postoperatively

Collaborators and Investigators

• Sponsor: Ziqiang Li
• Investigators: Study Director: Liziqiang Liziqiang, Doctor, Party

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2023
• Primary Completion (Estimated): May 1, 2024
• Study Completion (Estimated): October 1, 2025

Study Registration Dates

• First Submitted: March 5, 2024
• First Submitted That Met QC Criteria: March 12, 2024
• First Posted (Actual): March 20, 2024

Study Record Updates

• Last Update Posted (Actual): March 20, 2024
• Last Update Submitted That Met QC Criteria: March 12, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: acute kidney injury; tacrolimus; CYP3A5; gene polymorphism
• Additional Relevant MeSH Terms: Kidney Diseases; Urologic Diseases; Renal Insufficiency; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Wounds and Injuries; Acute Kidney Injury
• Other Study ID Numbers: JSZ007

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No