Dynamics of tacrolimus levels in renal transplant recipients
https://doi.org/10.58708/2074-2088.2024-2(32)-100-104
Abstract
We studied 35 medical histories of renal transplant recipients who underwent kidney transplantation in the surgical department (transplantation, reconstructive and endocrine surgery) of RRCRM&HE in Gomel. Tacrolimus concentrations were assessed on days 3, 10, and 30 after kidney transplantation. The tacrolimus C0 (zero concentration) level was determined fasting, before the morning administration of medications. Among kidney transplant recipients, there were 19 (54,3%) men and 16 (45,7%) women. The mean age was 42,7±2,0 years [95% CI 38,58; 46,73]. Before transplantation, 91,4% of patients were on programmed hemodialysis and 8.6% on peritoneal dialysis. All patients received triple immunosuppressive therapy: a calcineurin inhibitor (tacrolimus), antiproliferative drugs (azathioprine or mycophenolate mofetil), and prednisolone. Tacrolimus was administered at a dose of 0,1 mg/kg per day. According to our data, the concentration of tacrolimus on day 3 was 5,2 [4,1; 5,5] ng/ml, on day 10 it was 5,1 [2,5; 7,4] ng/ml (p3,10 = 0,809), on day 30 after surgery the tacrolimus level reached 8,2 [4,6; 10,2] ng/ml (p10,30 = 0,0007 and p3,30 = 0,027). Thus, when tacrolimus was administered at recommended doses, 8,6% of renal transplant recipients failed to achieve concentrations exceeding 4 ng/ml one month after surgery. Moreover, on day 30 of the postoperative period, the concentration of tacrolimus exceeded 7 ng/ml in 71% of renal transplant recipients.
About the Authors
S. L. Zyblev
ГУ «РНПЦ радиационной медицины и экологии человека»
Belarus
Belarus
A. E. Silin
ГУ «РНПЦ радиационной медицины и экологии человека»
Belarus
Belarus
V. N. Martinkov
ГУ «РНПЦ радиационной медицины и экологии человека»
Belarus
Belarus
S. V. Zybleva
ГУ «РНПЦ радиационной медицины и экологии человека»
Belarus
Belarus
A. V. Velichko
ГУ «РНПЦ радиационной медицины и экологии человека»
Belarus
Belarus
B. O. Kabeshev
ГУ «РНПЦ радиационной медицины и экологии человека»
Belarus
Belarus
References
1. Rabbit-ATG or basiliximab induction for rapid steroid withdrawal after renal transplantation (Harmony): an open-label, multicentre, randomised controlled trial / O. Thomusch [et al.] // Lancet. – 2017. – № 388. – Р. 3006-3016.
2. Use of pharmacogenetics to optimize immunosuppressant therapy in kidney-transplanted patients / V. Urzì Brancati [et al.] // Biomedicines. – 2022. – Vol. 10, №8. – Р. 1798.
3. Correlation between gene polymorphism and blood concentration of calcineurin inhibitors in renal transplant recipients: An overview of systematic reviews / L. Su [et al.] // Medicine (Baltimore). – 2019. – № 26. – Р. 16113.
4. Wolf, U. A drug safety concept (I) to avoid polypharmacy risks in transplantation by individual pharmacotherapy management in therapeutic drug monitoring of immunosuppressants / U. Wolf // Pharmaceutics. – 2023. – Vol. 15, №9. – Р. 2300.
5. Calcineurin inhibitor nephrotoxicity: a review and perspective of the evidence / N. Issa [et al.] // Am J Nephrol. – 2013. – Vol. 37, №6. – Р. 602-612.
6. Pharmacokinetic considerations related to therapeutic drug monitoring of tacrolimus in kidney transplant patients / L.M. Andrews [et al.] // Expert Opin Drug Metab Toxicol. – 2017. – Vol. 13, №12. – Р. 1225-1236.
7. The challenge of achieving target drug concentrations in clinical trials: experience from the Symphony study / H. Ekberg [et al.] // Transplantation. – 2009. – № 87. – Р. 1360-1366.
8. Reduction of extended-release tacrolimus dose in low-immunological-risk kidney transplant recipients increases risk of rejection and appearance of donor-specific antibodies: a randomized study / P. Gatault [et al.] // Am J Transplant. – 2017. – № 17. – Р. 1370-1379.
9. Opportunities to optimize tacrolimus therapy in solid organ transplantation: report of the european consensus conference / P. Wallemacq [et al.] // Ther Drug Monit. – 2009. – Vol. 31, №2. – Р. 139-152.
10. Therapeutic drug monitoring of Tacrolimus-Personalized therapy: second Consensus Report / M. Brunet [et al.] // Ther Drug Monit. – 2019. – Vol. 41, №3. – Р. 261-307.
11. Vanhove, T. Clinical determinants of calcineurin inhibitor disposition: a mechanistic review / T. Vanhove, P. Annaert, D.R.J. Kuypers // Drug Metab Rev. – 2016. – Vol. 48, №1. – Р. 88-112.
12. Pharmacogenomics of old and new immunosuppressive drugs for precision medicine in kidney transplantation / S. Turolo [et al.] // Journal of clinical medicine. – 2023. – Vol. 12, №13. – Р. 4454.
13. Wysocki, K. Pharmacogenomics in clinical care / K. Wysocki, D. Seibert // J. Am. Assoc. Nurse Pract. – 2019. – Vol. 31. – Р. 443-446.
14. Non-linear relationship between tacrolimus blood concentration and acute rejection after kidney transplantation: a systematic review and dose-response meta-analysis of cohort studies / S. Yin [et al.] // Curr. Pharm. Des. – 2019. – Vol. 25. – Р. 2394-2403.
Review
For citations:
Zyblev S.L., Silin A.E., Martinkov V.N., Zybleva S.V., Velichko A.V., Kabeshev B.O. Dynamics of tacrolimus levels in renal transplant recipients. Medical and Biological Problems of Life Activity. 2024;(2):100-104. (In Russ.) https://doi.org/10.58708/2074-2088.2024-2(32)-100-104
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