Treatment optimization of maintenance immunosuppressive agents in pediatric renal transplant recipients.
Treatment optimization of maintenance immunosuppressive agents in pediatric renal transplant recipients.
复制标题
儿童肾移植受者维持性免疫抑制剂的治疗优化。
DOI：
10.1080/17425255.2021.1943356
复制
发表时间：
2021
影响因子：
4.3
通讯作者：
Sherwin,CatherineM
中科院分区：
文献类型：
--
作者：
Job,KathleenM;Roberts,JessicaK;Enioutina,ElenaY;Illamola,SílviaM;Kumar,ShaunS;Rashid,Jahidur;Ward,RobertM;Fukuda,Tsuyoshi;Sherbotie,Joseph;Sherwin,CatherineM
引言：在过去的三十年里，儿童肾移植患者的移植物存活率显著增加，这与新的免疫抑制剂的发现和利用以及患者护理的改善有关。尽管患者移植物存活率有了这些进展，但仍需要改进，特别是在接受已故供体患者移植物的儿科患者的长期护理方面。维持性免疫抑制疗法的治疗指数狭窄，与高个体间和个体内variability.Areas覆盖：在这篇综述中，我们研究了肾移植的药代动力学变异性的影响，及其与年龄，遗传多态性，药物-药物相互作用，药物-疾病相互作用，肾功能不全，给药途径，品牌与仿制药配方。药效学概述了每种免疫抑制剂的作用机制，潜在的不良反应，药效学生物标志物的效用。专家意见：获得更好的定量了解免疫抑制剂的药代动力学和药效学成分，应帮助临床医生实施治疗方案，以保持治疗效果和药物相关毒性之间的平衡。
Introduction:Graft survival in pediatric kidney transplant patients has increased significantly within the last three decades, correlating with the discovery and utilization of new immunosuppressants as well as improvements in patient care. Despite these developments in graft survival for patients, there is still improvement needed, particularly in long-term care in pediatric patients receiving grafts from deceased donor patients. Maintenance immunosuppressive therapies have narrow therapeutic indices and are associated with high inter-individual and intra-individual variability.Areas covered:In this review, we examine the impact of pharmacokinetic variability on renal transplantation and its association with age, genetic polymorphisms, drug-drug interactions, drug-disease interactions, renal insufficiency, route of administration, and branded versus generic drug formulation. Pharmacodynamics are outlined in terms of the mechanism of action for each immunosuppressant, potential adverse effects, and the utility of pharmacodynamic biomarkers.Expert opinion:Acquiring abetter quantitative understanding of immunosuppressant pharmacokinetics and pharmacodynamic components should help clinicians implement treatment regimens to maintain the balance between therapeutic efficacy and drug-related toxicity.