Intra-patient variability in tacrolimus exposure: Causes, consequences for clinical management
Intra-patient variability in tacrolimus exposure: Causes, consequences for clinical management
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DOI：
10.1016/j.trre.2015.01.002
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发表时间：
2015-04-01
影响因子：
4
通讯作者：
Hesselink, Dennis A.
中科院分区：
文献类型：
--
作者：
Shuker, Nauras;van Gelder, Teun;Hesselink, Dennis A.
他克莫司（Tac）被广泛用于实体器官移植后排斥反应的预防。找到有效Tac浓度和毒性之间的最佳平衡是一项挑战，需要对治疗药物进行监测。除了众所周知的患者间变异性之外，Tac暴露的相当大的患者内变异性（IPV）也使Tac的临床使用复杂化。Tac IPV定义为在Tac剂量保持不变的一定时间内全血浓度的波动量。Tac暴露的高IPV最近被认为是急性排斥反应和长期肾移植结果不良的一个强有力的风险因素。除了不遵守，其他几个因素决定的IPV在Tac暴露的大小。IPV的定量很容易，可以很容易地纳入日常临床实践作为优化移植结果的工具。(C)2015 Elsevier Inc. All rights reserved.
Tacrolimus (Tac) is widely used for the prevention of rejection after solid organ transplantation. Finding the optimal balance between effective Tac concentrations and toxicity is a challenge and requires therapeutic drug monitoring. In addition to the well-known inter-patient variability, the clinical use of Tac is also complicated by considerable intra-patient variability (IPV) in Tac exposure. Tac IPV is defined as the amount of fluctuation of whole-blood concentrations over a certain period of time during which the Tac dose remains unchanged. A high IPV in Tac exposure has recently been recognized as a strong risk factor for acute rejection and poor long-term kidney transplantation outcome. In addition to non-adherence, several other factors determine the magnitude of the IPV in Tac exposure. Quantification of IPV is easy and can be easily incorporated into everyday clinical practice as a tool for optimizing transplantation outcomes. (C) 2015 Elsevier Inc. All rights reserved.