P036 Impact of the first wave of COVID-19 on the ERCP services in a single secondary endoscopy unit at the North of England: a retrospective analysis of the endoscopy database at royal lancaster infirmary

Abstract

col, based on our experience in initiating Symkevi ® in LT recipients, was to check tacrolimus levels at day 7 and day 14 after initiation and then again at day 28 along with liver function tests (LFTs). Results Kaftrio ® was initiated in 8 LT recipients. Of these patients, six were transplanted for CF-related liver disease (CFLD), one for CFLD and alpha one antitrypsin deficiency (a1-ATD) and one for a1-ATD alone. Four patients (50%) were male and the median age at Kaftrio ® initiation was 30 years (range 24-42 years). All patients had stable LFTs and a tacrolimus level that was within the desired therapeutic range prior to initiation.All 8 patients had stable LFTs following the initiation of Kaftrio ® (table 1). There was a clinically significant rise in tacrolimus level in 4 patients (figure 1) and a tacrolimus dose reduction (of 20-37.5%) was required in these patients. The rise in tacrolimus levels was evident at day 7 and levels returned to therapeutic range within one week of dose adjustment. There was evidence of toxicity (defined as a rise in creatinine from baseline or neurological toxicity) in one patient, most likely secondary to the rise in tacrolimus levels (table 1). Conclusion Our early experience suggests that it is safe to initiate Kaftrio ® in LT recipients. As anticipated, close therapeutic drug monitoring (TDM) of tacrolimus is necessary. We are continuing to monitor these patients to confirm that there are no longer-term effects on liver graft function or tacrolimus levels. Based on the findings of this case series, we recommend LT recipients being initiated on Kaftrio ® have weekly LFT and tacrolimus level monitoring for the first two weeks and then monthly for a further three months, until further data is available on the drug-drug interaction and its implications for tacrolimus dosing.