Immunosuppression
Immunosuppressive therapy after LT was based on the combination of
calcineurin inhibitor (tacrolimus) and mycophenolate mofetil (MMF). Two
types of twice-daily tacrolimus were used before the conversion: the
reference tacrolimus product (Prograf® ;
Astellas Pharma, Tokyo, Japan) and the generic formulation of tacrolimus
(Tacrobell® ; Chong Kun Dang Pharma, Seoul,
Korea). All patients were converted to once-daily tacrolimus
(Advagraf® , Astellas Pharma, Inc.,
Deerfield, IL, USA) on a 1:1 mg basis for the total daily dose. However,
some dose adjustments were permitted depending on the patient’s
condition, and other immunosuppressants were allowed to be used
according to standard practice. The serum trough levels of tacrolimus
and clinical assessments for safety and rejection were completed four
weeks after the conversion; then, parameters were evaluated routinely
according to the patient’s follow-up schedule. The doses of tacrolimus
at baseline and during follow-up were adjusted on an individual basis
according to the serum trough level of the drug.