WCN25-989 Challenges and Opportunities in Assessing Kidney Function in Simultaneous Heart-Kidney Transplant Candidates

11.8AE3 6.4ng/ml; on POD 3 was 14.4 AE6.8ng/ml and POD 6 was 12.62 AE4.8ng/ml.The standard arm (n16) were patients without tacrolimus genotype report.On POD 0 , 25% patients reached target tacrolimus level which improved to 31.25% on POD 3.Among Slow metabolizers, 32% patients had achieved target Tacrolimus levels on POD 0 and POD 3. Fast metabolizers, all of whom were given fluconazole, 19 % patients had achieved target tacrolimus dose of 8 to 12ng/ml on POD 0 which increased to 52% on POD 3. (P<0.05) .In slow metabolizers, the average dose of tacrolimus required to reach target levels was 0.095mg/ kg.Comparatively with the use of fluconazole , the dose required in fast metabolizers was only 0.12mg/kg/day.Studies in literature have shown fast metabolizers to need 1.5 to 2 times the dose of slow metabolizers.This is especially significant in countries where patients bear the cost of treatment out of pocket.Compared to standard arm, fast metabolizers who were given fluconazole had lesser number of patients on POD3 with suboptimal tacrolimus levels (<8ng/ml).Standard arm vs fast metabolizers was 14% vs 25%.Use of fluconazole was not associate with Tacrolimus toxicity(>12ng/ml).The percentage of patients with serum tacrolimus levels more than 12ng/ml in standard arm vs fast metabolizer vs slow metabolizer was significantly different at 43% vs 33% vs 60%.(p <0.05)