Prior Amiodarone Exposure Reduces Tacrolimus Dosing Requirements in Heart Transplant Recipients

Nadine T. Breslin, David M. Salerno, Veli K. Topkara, Farhana Latif, Susan Restaino, Koji Takeda, Hiroo Takayama, Maryjane Farr, Paolo C. Colombo, Douglas L. Jennings

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Introduction: Amiodarone use prior to heart transplant is independently associated with a higher rate of severe primary graft dysfunction and in-hospital mortality. Amiodarone may also alter the pharmacokinetics of medications metabolized via cytochrome P450. No data exist regarding the interaction between pretransplant amiodarone and tacrolimus concentrations. Design: Single-center retrospective study of transplant patients between January 1, 2014, and June 30, 2016. A therapeutic tacrolimus concentration was defined as a trough level between 8 and 15 ng/mL for 2 consecutive days. The primary outcome was the tacrolimus therapeutic weight-based dosing requirements (mg/kg/day) for patients receiving amiodarone prior to transplant when compared to those without prior receipt of amiodarone. Secondary outcomes include the incidence of cellular rejection and mortality within 6 months posttransplant. Results: Multi-organ transplant recipients (n = 3), retransplants (n = 9), those who died prior to a therapeutic level (n = 1), and those receiving amiodarone posttransplant (n = 7) were excluded from the analysis. Of the 80 patients included, 34 (42%) received amiodarone prior to transplant. Patient characteristics were similar, with the exception of primary graft dysfunction incidence (38% in amiodarone vs 8.5% in control, P =.001). The median therapeutic dose was 0.1 (interquartile range [IQR]: 0.07-0.12) versus 0.13 (IQR: 0.09-0.17) in the amiodarone and control groups, respectively, (P <.01). No significant difference in mortality or rejection was noted. Conclusion: Patients receiving amiodarone prior to transplant require a lower weight-based dose of tacrolimus.

Original languageEnglish (US)
Pages (from-to)129-134
Number of pages6
JournalProgress in Transplantation
Issue number2
StatePublished - Jun 1 2019
Externally publishedYes


  • amiodarone
  • heart transplantation
  • primary graft dysfunction
  • tacrolimus

ASJC Scopus subject areas

  • Transplantation


Dive into the research topics of 'Prior Amiodarone Exposure Reduces Tacrolimus Dosing Requirements in Heart Transplant Recipients'. Together they form a unique fingerprint.

Cite this