Long-Term Influence of CYP3A5 Gene Polymorphism on Pharmacokinetics of Tacrolimus and Patient Outcome after Living Donor Liver Transplantation

Background We investigated a long-term association between donor/recipient CYP3A5 polymorphisms, pharmacokinetics of tacrolimus, and recipient outcomes in settings of living donor liver transplantation (LDLT). Methods From February 2002 to November 2009, 67 couples of donor/recipients with tacrolimus administration, who could be genotyped for CYP3A5∗3 and∗1, were eligible in this study. We compared the dose-adjusted trough levels (C/D ratio) and dose/weight ratio of tacrolimus at 1 to 36 months postoperatively and recipient prognosis according to donor/recipient CYP3A5 polymorphisms;∗1∗1 in 7,∗1∗3 in 15, and∗3∗3 in 45, based on recipient genotype, and∗1∗1 in 1,∗1∗3 in 28, and∗3∗3 in 38, based on donor genotype. Results On the basis of the data from C/D ratio and dose/weight ratio of tacrolimus, the recipients who had∗1 allele and/or whose donor had∗1allele required significantly high doses of tacrolimus with, compared with those without, all through 3 years after transplantation. These data allowed us to show the importance of not only recipient CYP3A5 polymorphisms but also donor polymorphisms to obtain the target tacrolimus blood concentration. The overall survival rates of the recipients with∗1∗1 (5-year survival rate: 28.6%) were significantly unfavorable, which might have been caused by over-immunosuppression, compared with those with∗1∗3 (5-year survival rate: 78.8%) and∗3∗3 genotype (5-year survival rate: 84.3%). Conclusions Immune suppressive therapy with the use of tacrolimus should be tailored on the basis of CYP3A5 genotype, which may reduce the adverse effects and improve graft outcome.