Pharmacokinetic Advantages of Two-Hour Post-Dose Cyclosporin A Level for the Therapeutic Drug Monitoring in Stable Chinese Kidney Transplant Recipients

2005 ◽  
Vol 99 (3) ◽  
pp. c68-c72 ◽  
Author(s):  
Chi-Bon Leung ◽  
Cheuk-Chun Szeto ◽  
Chung-Shun Ho ◽  
Wai-Keung Law ◽  
Christopher Wai-Kei Lam ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Cyclosporin A ◽  
Kidney Transplant ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Dose

Impact of a Clinical Solid Organ Transplant Pharmacist on Tacrolimus Nephrotoxicity, Therapeutic Drug Monitoring, and Institutional Revenue Generation in Adult Kidney Transplant Recipients

2016 ◽  
Vol 26 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Shawn P. Griffin ◽  
Joelle E. Nelson
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Kidney Transplant ◽  
Drug Monitoring ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Therapeutic Drug ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Adult Kidney

Context: Tacrolimus requires close therapeutic drug monitoring (TDM) to ensure efficacy and minimize adverse effects. Pharmacists are uniquely positioned on transplant teams to interpret levels and recommend therapy modifications. Their impact in the immediate postoperative setting has not been described previously. Objective: To evaluate the impact of a clinical solid organ transplant pharmacist on nephrotoxicity, TDM, and revenue generation in adult kidney transplant recipients on tacrolimus. Design, Setting, and Patients: Retrospective assessment of adult kidney transplant recipients at University of Florida Health Shands Hospital. Intervention: A transplant pharmacist rounded 5 days a week and made medication recommendations on transplant recipients—including tacrolimus dose modifications based on levels. Pharmacy services were expanded to include medication reconciliation, medication counseling, and delivery of discharge medications to bedside. Main Outcome Measure: Incidence of nephrotoxicity during tacrolimus exposure. Results: Of the 70 kidney transplant recipients in the postpharmacist cohort, 18 (25.7%) experienced nephrotoxicity while on tacrolimus, compared to 18 (25%) of the 72 in the prepharmacist cohort ( P = .922). A significantly greater proportion of recipients who experienced nephrotoxicity were male, had hypertension, or experienced delayed or slow graft function. The rate of appropriately drawn tacrolimus troughs significantly increased from 23.4% to 30.3% in the postpharmacist cohort ( P < .001). The median outpatient pharmacy revenue generated per recipient significantly increased from US$345.49 (interquartile range [IQR]: 0-4727.56) to US$4834.95 per recipient (IQR: 3592.78-6224.60; P < .001). The length of stay (7 days, IQR: 6-9, vs 8 days, IQR: 6-9; P = .107) and the 30-day readmission rate were similar between groups (20.8% vs 21.4%; P = .931).

scholarly journals Transplant Prognosis in Kidney Transplant Recipients with Diabetes under Mycophenolic Acid-Focused Therapeutic Drug Monitoring

2021 ◽  
Vol 11 (11) ◽  
pp. 1224
Author(s):  
Eisuke Nakamura ◽  
Tadashi Sofue ◽  
Yasushi Kunisho ◽  
Keisuke Onishi ◽  
Kazunori Yamaguchi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Therapeutic Drug Monitoring ◽  
Kidney Transplant ◽  
Mycophenolic Acid ◽  
Drug Monitoring ◽  
Target Range ◽  
Therapeutic Drug ◽  
Prognostic Impact ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Mycophenolate mofetil is a key immunosuppressant that is metabolized into mycophenolic acid (MPA). The prognostic impact of MPA-focused therapeutic drug monitoring on allograft prognosis has not been determined in kidney transplant recipients with diabetes. In this study, we assessed the pharmacokinetics of MPA and allograft prognosis in recipients with diabetes. This study retrospectively analyzed 64 adult kidney transplant recipients. MPA blood concentration data (e.g., the time to the maximum concentration (Tmax), and the area under the concentration–time curve from 0 to 12 h (AUC0–12)) were collected at 3 weeks and 3 months after kidney transplantation. Of the 64 recipients, 15 had pre-existing diabetes. At 3 months after kidney transplantation, the Tmax of MPA was significantly longer in recipients with diabetes (mean (standard deviation): 2.8 (2.1) h) than in recipients without diabetes (1.9 (1.1) h, p = 0.02). However, the allograft estimated glomerular filtration rate and acute rejection rate, including borderline change, did not differ according to the diabetes status in patients with adjusted AUC0–12 of MPA within the target range. In conclusion, a longer Tmax of MPA was observed in recipients with diabetes; however, acceptable allograft prognosis was observed in kidney transplant recipients with diabetes and a sufficient AUC0–12 of MPA.

Knowledge of immunosuppressive drugs used in kidney transplants

2012 ◽  
Vol 21 (13) ◽  
pp. 795-800
Author(s):  
Mas Linda Mohamad ◽  
Li Yang ◽  
Xu Jin ◽  
Priscilla Tan Lee Eng ◽  
Terence Kee Yi Shern
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Kidney Transplant ◽  
Drug Monitoring ◽  
Education Programme ◽  
Immunosuppressive Drugs ◽  
Therapeutic Drug ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
High Dependency ◽  
Kidney Transplant Patients

Aim: A key role of renal nurses is the correct and safe administration of immunosuppressive drug therapy (ImmRx) to kidney transplant recipients. The authors sought to examine the knowledge and competency of ImmRx in kidney transplant patients and whether an annual kidney transplant nurse education programme had any beneficial effects. Methods: The study population was comprised of 63.2% (n=50/79) of all nurses from renal wards (ward A (n=17/35), ward B (n=21/32)) and 12 nurses from a high-dependency urology ward (ward C (n=12)). Kidney transplant patients usually receive inpatient care in wards A, B or C only as these wards specialise in urology and renal care. Each nurse completed a 35-question test that covered ImmRx in areas of indication, identification, interaction, pharmcokinetics/pharmacodynamics, therapeutic drug monitoring, administration and adverse effects. A minimum score of 70% was required to pass the test. Results: Only 46% of participants passed the test. The proportion of nurses who passed was not significantly different with respect to years of nursing experience, professional rank, postgraduate nursing qualifications or ward location. Unexpectedly, a greater proportion of nurses who did not attend the education programme passed the test (63.6%; n=14/22) than those who did attend it (32.1%; n=9/28]; p=0.03). Notably, 24% (n=12/50), 4% (n=2/50) and 4% (n=2/50) were unable to correctly answer any of the identification, interaction and therapeutic drug monitoring questions. Conclusion: These findings suggest that the nurses' understanding and knowledge of ImmRx is insufficient and they need to update their knowledge on ImmRx continually.

Immunosuppressive Management of Pediatric Kidney Transplant Recipients

2020 ◽  
Vol 26 (28) ◽  
pp. 3451-3459
Author(s):  
Tomáš Seeman
Keyword(s):  
Immunosuppressive Therapy ◽  
Kidney Transplant ◽  
Induction Therapy ◽  
Graft Loss ◽  
Calcineurin Inhibitors ◽  
Mtor Inhibitors ◽  
Therapeutic Drug ◽  
High Dose ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

: Kidney transplantation is a preferable treatment of children with end-stage kidney disease. All kidney transplant recipients, including pediatric need immunosuppressive medications to prevent rejection episodes and graft loss. : Induction therapy is used temporarily only immediately following transplantation while maintenance immunosuppressive drugs are started and given long-term. There is currently no consensus regarding the use of induction therapy in children; its use should be decided based on the immunological risk of the child. : The recent progress shows that the recommended strategy is to use as maintenance immunosuppressive therapy a combination of a calcineurin inhibitor (preferably tacrolimus) with an antiproliferative drug (preferably mycophenolate mofetil) with steroids that can be withdrawn early or late in low-risk children. The mTOR-inhibitors (sirolimus, everolimus) are used rarely in pediatrics because of common side effects and no evidence of a benefit over calcineurin inhibitors. The use of calcineurin inhibitors, mycophenolate, and mTOR-inhibitors should be followed by therapeutic drug monitoring. : Immunosuppressive therapy of acute rejection consists of high-dose steroids and/or anti-lymphocyte antibodies (T-cell mediated rejection) or plasma exchange, intravenous immunoglobulines and/or rituximab (antibodymediated rejection). : The future strategies for research are mainly precise characterisation of children needing induction therapy, more specific indications for mTOR-inhibitors and for the far future, the possibility to reach the immuno tolerance.

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