Achievement of tacrolimus therapeutic range in renal transplant patient
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Abstract
Background: Tacrolimus is an immunosuppressive drug in the Calcineurin inhibitors that indicated for the prevention of graft rejection in kidney and liver transplant patients. Pharmacokinetics of tacrolimus has been reported to vary between individuals. This study was conducted to evaluate tacrolimus levels before the next dose in renal transplant patients more than 3 months by determining the percentage of tacrolimus at trough concentration within the therapeutic range, percentage of increasing serum creatinine and the relationship between drug levels and an increasing serum creatinine. Method: A retrospective Study collected data in renal transplant patients who were admitted to Srinagarind Hospital and received tacrolimus. Measurement of tacrolimus levels were done between June 1, 2011 to May 31, 2012. Subjects were patients older than 18 years who received a kidney transplant more than 3 months. Patients with poor compliance were excluded. A total of 154 patients from 186 patients with 964 tacrolimus levels were recruded into study. Odds ratios were estimated to describe the associations between drug levels and increasing in serum creatinine Result: Tacrolimus level were in sub -therapeutic 692 times (72.54%). The levels of serum creatinine (Scr) increased from baseline 25 to 50 percent and more than 50 percent 17.2% and 14.74%, respectively. Only one drug level was in supratherapeutic (0.10%). The study found that subtherapeutics of tacrolimus did not associate with affect the increasing serum creatinine compare with the therapeutic (OR = 1.132; 95% CI 0.829-1.546). Moreover there were 6 patients who had graft rejections with proven by kidney biopsy. They had drug level lower than therapeutics 29 times and within therapeutics 3 times. Conclusion: The most of tacrolimus levels were lower than the therapeutic range. However, the relationship between the levels of drugs with the increasing in serum creatinine is not statistically significant. So further study should be studied about factors effect on renal function and/or appropriated biomarkers to evaluated renal function and therapeutic range of tacrolimus at each period after transplantation by prospective study should be performed.
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