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Abstract
Background: Tacrolimus is immunosuppressive agent used for the prevention of rejection in kidney transplant patients, has narrow therapeutic range, and variable pharmacokinetics. Objectives: To identify the optimum Tacrolimus blood trough level for Saudi kidney transplant patients (SKTP). Method: The research population consisted of 100 SKTP at the Armed Forces Hospital in the Southern Region (AFHSR) treated with Tacrolimus and followed-up for a period of 24 months (2012 till 2014). Results: A significant relationship between Tacrolimus trough level and incidence of kidney rejection was remarkably found only after 180 days post-transplantation. During this period, Tacrolimus mean trough level (ng/ml) was 7.4 ± 0.2 in SKTP with no rejection, 5.3 ± 0.7 for those with acute rejection, and 3.8 ± 0.4 for those with chronic rejection. Furthermore, the coefficient of variation (CV%) which reflects fluctuation in Tacrolimus trough level, was obviously high in SKTP with acute rejection in all post-kidney-transplant periods. Conclusion: After 6 month post- kidney transplantation in SKTP, Tacrolimus trough level (
Highlights
Organ transplantation requires lifelong pharmacotherapy with combination of immunosuppressant drugs which include a steroid, and immune modulator (e.g. mycophenolate mofetil, and a calcineurin inhibitor (CNI) like cyclosporine A and Tacrolimus [1].Tacrolimus became an essential component of immunosuppressant regimens in most transplant centers
Outcome measurement Parameters used for measurement of outcomes in this study included: acute and chronic rejection kidney rejection as indicated by clinical manifestations, biopsy test and histo-pathological findings
The results provided an impression that Saudi kidney transplant patients (SKTP) received kidney from living related donor showed a relatively lower incidence of rejection episodes compared to those received cadaveric kidney
Summary
Organ transplantation requires lifelong pharmacotherapy with combination of immunosuppressant drugs which include a steroid, and immune modulator (e.g. mycophenolate mofetil, and a calcineurin inhibitor (CNI) like cyclosporine A and Tacrolimus [1].Tacrolimus became an essential component of immunosuppressant regimens in most transplant centers. Its mechanism involve selective suppression of T-lymphocyte and its pharmacokinetic is quite variable among individuals and influenced by so many variables such as race, time after transplantation and other chronic illness. It is extensively metabolized in the liver by cytochrome P450 3A system (CYP3A), which is subject to considerable inter-individual variation and drug interaction [2]. Tacrolimus is liable for several drug interactions, primarily with agents affecting the cytochrome P-450 system which include food and herbal medicines These interactions may lead to serious toxicity or rejection of the transplanted organ [3]. Tacrolimus is immunosuppressive agent used for the prevention of rejection in kidney transplant patients, has narrow therapeutic range, and variable pharmacokinetics
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