A comprehensive review of the impact of tacrolimus intrapatient variability on clinical outcomes in kidney transplantation. Issue 8 (17th June 2020)

• Record Type: Journal Article
• Authors: Gonzales, Haley M.; McGillicuddy, John W.; Rohan, Vinayak; Chandler, Jessica L.; Nadig, Satish N.; Dubay, Derek A.; Taber, David J.
• Is Part Of: American journal of transplantation. Volume 20:Issue 8(2020)
• Page Start: 1969
• Page End: 1983
• Publication Date: 2020-06-17
• Subjects: graft survival -- health services and outcomes research -- immunosuppressant ‐ calcineurin inhibitor: tacrolimus -- kidney transplantation/nephrology; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16002
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Tacrolimus (Tac) is widely used to prevent rejection and graft loss in solid organ transplantation. A limiting characteristic of Tac is the high intra and interpatient variability associated with its use. Routine therapeutic drug monitoring (TDM) is necessary to facilitate Tac management and to avoid undesirable clinical outcomes. However, whole blood trough concentrations commonly utilized in TDM are not strong predictors of the detrimental clinical outcomes of interest. Recently, researchers have focused on Tac intrapatient variability (Tac IPV) as a novel marker to better assess patient risk. Higher Tac IPV has been associated with a number of mechanisms leading to shortened graft survival. Medication nonadherence (MNA) is considered to be the primary determinant of high Tac IPV and perhaps the most modifiable risk factor. An understanding of the methodology behind Tac IPV is imperative to its recognition as an important prognostic measure and integration into clinical practice. Therapeutic interventions targeting MNA and reducing Tac IPV are crucial to improving long‐term graft survival. Abstract : This is a comprehensive review of tacrolimus intrapatient variability, including current measurement and reporting methods, its impact on clinical outcomes, and the clinical implications of this novel metric in kidney transplantation.