THERAPEUTIC DRUG MONITORING OF TACROLIMUS IN THAI LIVER TRANSPLANT PATIENTS
DOI:
https://doi.org/10.14456/tbps.2023.5Keywords:
therapeutic drug monitoring, tacrolimus, patients, liver transplantation, ThaiAbstract
Tacrolimus, despite being a highly effective immunosuppressant used to prevent allograft rejection in liver transplantation, has a narrow therapeutic index with a high level of pharmacokinetic variability. Therefore, therapeutic drug monitoring of tacrolimus is essential in order to warrant any intervention required to optimize the tacrolimus doses and the therapeutic drug levels. By reporting the tacrolimus regimens and the result of the therapeutic drug monitoring of tacrolimus during the first 6 months after liver transplantation in Thai patients, this study aims to develop and improve the pharmaceutical care processes, including the better therapeutic drug monitoring in liver transplant patients. The descriptive retrospective study is based on the data collected over the past 12 years 3 months from liver transplant patients at Ramathibodi Hospital. The data indicates that immediate-release tacrolimus, together with mycophenolate mofetil and prednisolone, constituted the main immunosuppressive regimen prescribed in these Thai liver transplant patients. The average initial tacrolimus dose was 3.16 mg/day (0.05 mg/kg/day) which mostly started at the second day after the operation, and then the tacrolimus doses would be carefully adjusted according to the trough tacrolimus levels to achieve the tacrolimus target levels in each transplantation period. A total of 2,298 trough tacrolimus levels from 61 recipients receiving oral immediate-release tacrolimus were analyzed. Furthermore, the study shows that there was 14.32 – 24.82 % of tacrolimus levels in therapeutic ranges. The highest coefficient of variation (%CV) of trough tacrolimus levels was 56.79% which was found during the first 7 days following the liver transplantation. The coefficient of variation subsequently declined after 3 months of the transplantation. The therapeutic drug monitoring of tacrolimus is therefore crucial to providing the optimal individual tacrolimus doses and to maintaining therapeutic target levels, especially during the first 6 months post-transplantation in which the patients are at high risk of graft rejection due to unstable clinical manifestations and unsteady tacrolimus levels.
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