Tacrolimus and sirolimus in capillary dried blood spots allows for remote monitoring
Tacrolimus and sirolimus in capillary dried blood spots allows for remote monitoring
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DOI：
10.1111/petr.12392
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发表时间：
2015-02-01
影响因子：
1.3
通讯作者：
Jack, Rhona M.
中科院分区：
文献类型：
--
作者：
Dickerson, Jane A.;Sinkey, Marian;Jack, Rhona M.
他克莫司和西罗莫司的治疗药物监测在接受IMS治疗的移植患者的临床随访中起着重要作用。移植的成功和良好的患者结局依赖于维持足够的治疗药物水平。本研究的目的是评估远程采集DBS用于免疫抑制剂监测的临床效用，并比较静脉全血和DBS配对采集中的IMS水平。西罗莫司和他克莫司水平在临床上与从儿科移植后患者的静脉全血采集的手指戳的毛细血管血相关。参与者将干血斑卡带回家，用一个预先写好地址、邮资已付的信封寄回实验室。总体而言，观察到较小但具有统计学显著性的负偏倚（-0.6 ng/mL，p=0.0011）。进行了病历审查，以评估临床管理是否会发生变化，没有病例显示有临床意义的变化。DBS中的西罗莫司也与静脉水平相关。总体而言，观察到较小但具有统计学意义的负偏倚（-0.8 ng/mL，p=0.029）。总之，DBS中IMS水平的分析是可能的，毛细血管和静脉血之间的差异在临床可接受的限度内。
Therapeutic drug monitoring of tacrolimus and sirolimus plays a significant role in the clinical follow-up of transplant patients receiving IMS therapy. Success of transplant and favorable patient outcome relies on maintaining adequate therapeutic drug levels. The purpose of this research is to assess the clinical utility of remote collection of DBS for immunosuppressant monitoring and compare the IMS level in paired collections of venous whole blood and DBS. Sirolimus and tacrolimus levels were clinically correlated in capillary blood collected from a finger poke with venous whole blood from pediatric, post-transplant patients. The participants took the dried blood spot card home with them with a pre-addressed, postage-paid envelope and mailed it back to the laboratory. Overall, a small but statistically significant negative bias was observed (-0.6ng/mL, p=0.0011). A chart review was performed to assess whether clinical management would have changed, and none of the cases revealed a clinically significant change. Sirolimus in DBS also correlated with venous levels. Overall, a small but statistically negative bias was observed (-0.8ng/mL, p=0.029). In summary, analysis of IMS levels in DBS is possible, and the difference noted between capillary and venous blood is within the clinically acceptable limits.