Transplant: Tacrolimus, What’s Your Target Range?

Hi @bosco17 Unlike a solid organ transplant, a bone marrow transplant doesn’t require life-long anti-rejection meds after 6 months or in some cases longer. I was on varying doses for about 2.5 years to avoid graft vs host disease. The last taper was .5mg for 6+months. I’ve have been off tacro for just over a year now.

As a disclaimer, because everyone’s body chemistry is different, it’s not really productive or beneficial to compare reactions to a medication with someone else’s experience. I tolerated certain medications really well for my transplant. But a friend whom I met while going through our transplants at the same time, could not take the same meds. She reacted quite differently to the same drugs, same dosages.

That being said, I’ll give you my GFR numbers but please don’t base your potential reaction on how my body reacted to the tacro. And when it did react, my levels were very high. Not at .5mg. In all honesty, we don’t know if it was the tacro that caused the issues or combination of all the meds and having my bone marrow transplant. Tacro wasn’t the only medication I was taking. There were 8 other meds.

I love having a patient portal because I was able to take a trip down memory lane this morning and see numbers pre and post transplant (BMT)
Before the bmt, my GFR was in the 90s. The first month after bmt, it dropped to mid 70s. There are certain meds which can hold the tacro in the body for longer periods. I’d gone through a med adjustment a month later that sent my normal tacro trough of 7 soaring to 22.6. I was horribly ill for a few days. My kidneys went into failure and my GFR dropped to 27. By the next week I was back in 40s for GFR. Over the course of the next year I tapered down to .5mg tacro and GFR evened out to between 52 - 59. It’s still there after a year off tacro and we’re quite happy with that.

From my understanding, tacro, at higher dosages reduces blood flow through the kidneys which lowers the GFR. In my case, as my doctor predicted, with a drop in my tacro dosage my kidneys would improve. He was spot on. I tolerated .5mg very well with no side effects except a slight hand tremble. Nothing noteworthy. It’s a very beneficial anti-inflammatory medication.

Again, I’m not a doctor and have no knowledge of the differences between the cyclosporine dosages 25mg 2 x daily and the .5mg of tacro that’s being suggested for you.
But at .5mg it is a really low dosage and worth a try to get off the other med that’s causing issues with your health.
Because of your past history, your tacro trough should be checked often initially to keep tabs on the blood level. At this low level nothing should happen quickly that can’t be reversed if you stop taking the med. But you don’t have the luxury of not having an anti rejection drug. This small dosage might be just the trick.
You might also have your magnesium level checked. That can be depleted quickly with tacro. Magnesium glycinate is a good replacement with minimal gut issues. Do you have that done?

Hi basco
I just had blood work this week my tacro was 2 but my liver enzymes are elevated, from what my TP team has told me they r not concerned w/the tacro at this point in my LT only the liver enzymes? So I am thinking every center is different. They r to contact me Monday about my enzymes, first time in 2yrs. that I have had them elevated. Not sure why..

Whew, that makes me feel a little better this the first time for me.
I have labs done monthly, yes it scared me b/c u think oh no what’s happening to my new liver.
Yes, I have felt a little tired but nothing that worried me but I did get a new puppy who had kennel cough and then got parvo so maybe she gave me something? Just not sure.
Thank you so much for your help😊
Happy Thanksgiving 🍁