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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Dissertation
Joint modelling of longitudinal and time-to-event data : analysis of predictive factors of graft outcomes in kidney transplant recipients
TL;DR: The individual predicted probabilities of graft failure up to 10 years posttransplantation, calculated from this joint model were satisfying in terms of sensitivity, specificity and overall accuracy, for patients who had not developed de novo donor specificanti-HLA antibodies.
Journal ArticleDOI
Use of phenytoin for treatment of tacrolimus toxicity with superimposed sepsis.
TL;DR: A 40-year-old woman with a history of chronic graft-versus-host-disease on immunosuppression with tacrolimus presented to the hospital with somnolence, confusion and muscle cramps, and cessation of tacolimus with concomitant administration of intravenous phenytoin led to the successful reduction of elevated tacro Limus concentrations.
Journal ArticleDOI
Correlation between Cyclosporine Blood Levels and Area under Blood Concentration Time Curve in Iraqi Bone Marrow Transplant Patients Treated with Neoral® Oral Solution
TL;DR: It is concluded from this study that a single blood sample obtained at 2 h post-dosing and possibly at 3 h post dosing (C3) are ideal surrogate indexes for reflecting total drug exposure, and therefore may be used in clinical practice for predicting therapeutic and toxic effects of cyclosporine.
Journal ArticleDOI
The effect of CYP3A5 polymorphism on cyclosporine plasma level in Egyptian renal transplant recipients
Bahaa Zayed,Dina A. Mehaney +1 more
TL;DR: Evaluated the effect of CYP3A5*3 polymorphism on CsA plasma levels in Egyptian renal transplant patients at the first week and first month of transplantation to elucidate their pharmacogenetic role in kidney transplant patients.
Journal ArticleDOI
Efficacy and safety of three times daily dosing of tacrolimus in pediatric kidney transplantation patients: A single-center comparative study.
TL;DR: No significant difference was observed between tacrolimus BID and TID dosing in the time to reach therapeutic trough concentration or in the proportion of patients achieving therapeutic trough concentrations at day 7.
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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