Therapeutic Monitoring of Calcineurin Inhibitors for the Nephrologist
TLDR
The purpose of this article is to review the current understanding of CNI pharmacokinetics and its relevance to proper dosing and monitoring of these medications and discusses the effect of adjunctive immunosuppressive agents on CNI Pharmacokinetic and dosing.Abstract:
The calcineurin inhibitors (CNI) cyclosporine and tacrolimus remain the backbone of immunosuppression for most kidney transplant recipients. Despite many years of experience, protocols that optimize efficacy with minimal toxicity remain a subject of debate. Nevertheless, studies of the pharmacokinetic properties of the CNI, particularly cyclosporine, have led to improved dosing strategies. The purpose of this article is to review the current understanding of CNI pharmacokinetics and its relevance to proper dosing and monitoring of these medications. This article also reviews the trials that have helped to define the optimal dosages and discusses the effect of adjunctive immunosuppressive agents on CNI pharmacokinetics and dosing.read more
Citations
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Book ChapterDOI
Overview of Immunosuppressive Therapies in Renal Transplantation
Steven Gabardi,Eric M. Tichy +1 more
TL;DR: This chapter will review the currently available immunosuppressive agents used for induction and maintenance therapy and focus on their pharmacology, dosing, adverse event profile and clinical efficacy.
Journal ArticleDOI
Effect of CYP3A4*22 and CYP3A4*1B but not CYP3A5*3 polymorphisms on tacrolimus pharmacokinetic model in Tunisian kidney transplant.
Ibtissem Hannachi,Ibtissem Hannachi,Nadia Ben Fredj,Zohra Chadli,Najah Ben Fadhel,Haifa Ben Romdhane,Yvan Touitou,Naceur A. Boughattas,Amel Chaabane,Karim Aouam +9 more
TL;DR: This model was very useful in the Tac dose proposal in this population on any PT day but could not be used in other organ transplants due to pharmacokinetic differences.
Journal ArticleDOI
Immunophenotypic profile and clinical outcome of monoclonal B-cell lymphocytosis in kidney transplantation.
Gaetano Alfano,Francesco Fontana,Elisabetta Colaci,Erica Franceschini,Giulia Ligabue,Andrea Messerotti,Francesca Bettelli,Antonella Grottola,William Gennari,Leonardo Potenza,Giovanni Guaraldi,Cristina Mussini,Mario Luppi,Gianni Cappelli +13 more
TL;DR: The data suggest that MBL is an age‐related disorder, with non‐CLL MBL being the most common subtype among KT recipients, and all cases were also affected by concomitant monoclonal gammopathy of undetermined significance.
Journal ArticleDOI
Aggressive immunosuppressant reduction and long-term rejection risk in renal transplant recipients with Pneumocystis jiroveci pneumonia.
TL;DR: Aggressive immuno-suppressant dosage reduction is safe in such circumstance and is associated with minimal risk of in-hospital and long-term acute allograft rejection.
References
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Journal ArticleDOI
Cyclosporine-associated chronic nephropathy
TL;DR: It is concluded that long-term cyclosporine therapy may lead to irreversible and potentially progressive nephropathy and should be used with restraint and caution until ways are found to mitigate its nephrotoxicity.
Journal ArticleDOI
A comparison of tacrolimus (FK506) and cyclosporine for immunosuppression after cadaveric renal transplantation. FK506 Kidney Transplant Study Group
TL;DR: Tacrolimus is more effective than cyclosporine in preventing acute rejection in cadaveric renal allograft recipients, and significantly reduces the use of antilymphocyte antibody preparations.
Journal ArticleDOI
Cyclosporin a initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers
R.Y. Calne,Keith Rolles,Sathia Thiru,McMaster P,G.N. Craddock,S. Aziz,D.J.G. White,D. B. Evans,D.C Dunn,R.G. Henderson,P. Lewis +10 more
TL;DR: 34 patients treated with cyclosporin A received 36 cadaveric organ allografts, 26 kidneys are still supporting life, 3 after more than a year; the pancreases and livers are also functioning.
Journal ArticleDOI
Efficacy of sirolimus compared with azathioprine for reduction of acute renal allograft rejection: a randomised multicentre study
TL;DR: Use of sirolimus reduced occurrence and severity of biopsy-confirmed acute rejection episodes with no increase in complications and further studies are needed to establish the optimum doses for the combined regimen.
Journal ArticleDOI
Multicenter randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection - A report of the European Tacrolimus Multicenter Renal Study Group
AD Mayer,Jean-Paul Squifflet +1 more
TL;DR: A significant reduction in the incidence of episodes of allograft rejection observed with tacrolimus therapy may have important long-term implications given the prognostic influence of rejection on graft survival.
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