Abstract
Tacrolimus, the keystone immunosuppressive drug administered after solid organ transplantation, presents a narrow therapeutic index and wide inter- and intra-patient pharmacokinetic variability (IPV). The latter has been fairly studied in kidney transplantation, where it could impact outcomes. However, literature about other transplanted organ recipients remains inconclusive. This review aimed at summarizing the evidence about the IPV of tacrolimus concentrations outside of the scope of kidney transplantation. First, factors influencing IPV will be presented. Then, the potential of IPV as a biomarker predictive of graft outcomes will be discussed in liver, heart, lung and pancreas transplantation. Lastly, strategies to reduce IPV will be reviewed, with the ultimate objective being ready-to-implement solutions in clinical practice by transplantation professionals.
Highlights
Pharmaceutics 2022, 14, 379. https://In recent years, intra-patient variability (IPV) of immunosuppressive (IS) drugs concentrations has surfaced as a potential novel biomarker in solid organ transplant recipients’management
Most of the studies published on that topic so far refer to kidney transplantation, but it has been shown that IPV might impact other solid organ transplantation (SOT)
IPV appears as an interesting tool to monitor TAC therapy and, to a limited extent, predict its effects
Summary
Intra-patient variability (IPV) of immunosuppressive (IS) drugs concentrations has surfaced as a potential novel biomarker in solid organ transplant recipients’. With tacrolimus (TAC), patients with higher IPV might have worse outcomes when considering inflammation, graft rejection, and patient and graft survival. The mechanism behind this process may be related to the alternation of over and under-subclinical immunosuppression episodes. Most of the studies published on that topic so far refer to kidney transplantation, but it has been shown that IPV might impact other solid organ transplantation (SOT). The aim of the present review is to summarize the information on TAC IPV and its consequence in SOT, excluding kidney transplantation.
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