THERAPEUTIC DRUG MONITORING OF TACROLIMUS IN THAI LIVER TRANSPLANT PATIENTS
DOI:
https://doi.org/10.69598/tbps.18.1.57-69Keywords:
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.
References
Nivatvongs S, Sirichindakul B, Nontasuti B, Kongkam P, Rerknimitr R, Kullavanijaya P. Result of orthotopic liver transplantation at King Chulalongkorn Memorial Hospital: the first series from Thailand. J Med Assoc Thai. 2003;86 Suppl 2:S445-50
Thai Transplantation Society. Thai transplant annual report 2020 [Internet]. Bangkok: The Society; 2020 [cited 2022 July 1]. Available from: https://www.transplantthai.org/data/ annual_report/ 1/2020%20TH.pdf (in Thai)
McAlister VC, Haddad E, Renouf E, Malthaner RA, Kjaer MS, Gluud LL. Cyclosporin versus tacrolimus as primary immunosuppressant after liver transplantation: a meta-analysis. Am J Transplant. 2006;6(7):1578-85.
Lemaitre F, Tron C, Renard T, Jézéquel C, Houssel-Debry P, Bergeat D, et al. Redefining therapeutic drug monitoring of tacrolimus in patients undergoing liver transplantation: a target trough concentration of 4-7 ng/mL during the first month after liver transplantation is safe and improves graft and renal function. Ther Drug Monit. 2020;42(5):671-8.
EASL Clinical practice guidelines: liver transplantation. J Hepatol. 2016;64(2):433-85.
Thai Transplantation Society. Thai transplant care (TTC) liver [Internet]. Bangkok: The Society; 2015 [cited 2022 July 1]. Available from: http://www.transplantthai.org/ upload/170815114538293_MNB.pdf (in Thai)
Zhang Y YJ, Zhu LQ and Wang N. Effects on pharmacokinetics of tacrolimus in liver transplant patients. SM J Pharmac Ther. 2016;2(1):1012.
Tharanon V, Sobhonslidsuk A, Intaraprasong P, Sra-ium S, Sakulchairungrueng B, Gesprasert G, et al. Population pharmacokinetics of tacrolimus in Thai liver transplant patients. Thai Bull Pharm Sci. 2021; 16(1):17-30.
Varghese J, Reddy MS, Venugopal K, Perumalla R, Narasimhan G, Arikichenin O, et al. Tacrolimus-related adverse effects in liver transplant recipients: its association with trough concentrations. Indian J Gastroenterol. 2014;33(3):219-25.
Touw DJ, Neef C, Thomson AH, Vinks AA. Cost-effectiveness of therapeutic drug monitoring: a systematic review. Ther Drug Monit. 2005;27(1):10-7.
Wallemacq P, Goffinet JS, O'Morchoe S, Rosiere T, Maine GT, Labalette M, et al. Multi-site analytical evaluation of the Abbott ARCHITECT tacrolimus assay. Ther Drug Monit. 2009;31(2):198-204.
Wallemacq P, Armstrong VW, Brunet M, Haufroid V, Holt DW, Johnston A, et al. Opportunities to optimize tacrolimus therapy in solid organ transplantation: report of the European consensus conference. Ther Drug Monit. 2009;31(2):139-52.
Lexi-Drugs/Tacrolimus. Lexicomp app. UpToDate Inc. Accessed October 8, 2022.
Rayar M, Tron C, Jezequel C, Beaurepaire JM, Petitcollin A, Houssel-Debry P, et al. High intrapatient variability of tacrolimus exposure in the early period after liver transplantation is associated with poorer outcomes. Transplantation. 2018;102(3):e108-e14.
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