A Comprehensive Review of the Impact of Tacrolimus Intrapatient Variability on Clinical Outcomes in Kidney Transplantation

Overview

Journal Am J Transplant

Publisher Elsevier

Specialty General Surgery

Date 2020 May 15

PMID 32406604

Citations 29

Authors

Haley M Gonzales

John W McGillicuddy

Vinayak Rohan

Jessica L Chandler

Satish N Nadig

Derek A Dubay

David J Taber

Affiliations

Soon will be listed here.

Abstract

Tacrolimus (Tac) is widely used to prevent rejection and graft loss in solid organ transplantation. A limiting characteristic of Tac is the high intra and interpatient variability associated with its use. Routine therapeutic drug monitoring (TDM) is necessary to facilitate Tac management and to avoid undesirable clinical outcomes. However, whole blood trough concentrations commonly utilized in TDM are not strong predictors of the detrimental clinical outcomes of interest. Recently, researchers have focused on Tac intrapatient variability (Tac IPV) as a novel marker to better assess patient risk. Higher Tac IPV has been associated with a number of mechanisms leading to shortened graft survival. Medication nonadherence (MNA) is considered to be the primary determinant of high Tac IPV and perhaps the most modifiable risk factor. An understanding of the methodology behind Tac IPV is imperative to its recognition as an important prognostic measure and integration into clinical practice. Therapeutic interventions targeting MNA and reducing Tac IPV are crucial to improving long-term graft survival.

Citing Articles

Immunosuppressant nonadherence profile in kidney transplant recipients and the impact of medication adherence on transplant outcomes.

Zhi-Yu Z, Lin-Rui D, Chen-Zhen Y, Ren-Jie C, Fei-Hong Y, Song C Front Pharmacol. 2025; 15:1493166.

PMID: 39744122 PMC: 11688411. DOI: 10.3389/fphar.2024.1493166.

Tacrolimus Dose Requirement in Adult Kidney Transplant Patients Treated With Adoport Can Be Anticipated.

Marquet P, Anglicheau D, Humeau A, Adrouche S, Saada L, Bisiaux J Transpl Int. 2024; 37:13495.

PMID: 39469664 PMC: 11513580. DOI: 10.3389/ti.2024.13495.

Can Pre-Transplant Psychometric Testing Predict Tacrolimus Intrapatient Variability After Living Kidney Transplantation?.

Lee A, Lee S, Kang W, Cho A, Kim J, Park J Psychiatry Investig. 2024; 21(7):718-725.

PMID: 39089697 PMC: 11298269. DOI: 10.30773/pi.2024.0058.

Impact of intra-patient variability of tacrolimus on allograft function and CD4 + /CD8 + ratio in kidney transplant recipients: a retrospective single-center study.

Wang X, Liu Z, Chen J, Chai Y, Shao X, Xie W Int J Clin Pharm. 2024; 46(4):918-925.

PMID: 38814512 DOI: 10.1007/s11096-024-01726-w.

The Influence of Tacrolimus Exposure and Metabolism on the Outcomes of Kidney Transplants.

Maslauskiene R, Vaiciuniene R, Radzeviciene A, Tretjakovs P, Gersone G, Stankevicius E Biomedicines. 2024; 12(5).

PMID: 38791087 PMC: 11117915. DOI: 10.3390/biomedicines12051125.

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