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Achieving target concentrations of tacrolimus is important – if levels are too low, then there is a risk of transplant rejection, if levels are too high, there is a risk of drug toxicities. There is evidence to suggest that dosing patients based on rs776746 genotype can result in faster and more frequent achievement of target tacrolimus levels.
Typically, this is in the setting of kidney transplantation or multi-organ transplantation. [5] Presentation in these immunocompromised individuals is much more severe. Clinical manifestations include renal dysfunction (seen by a progressive rise in serum creatinine), and an abnormal urinalysis revealing renal tubular cells and inflammatory cells.
Tacrolimus (trade names Prograf, Astagraf XL, Envarsus XR) is a product of the bacterium Streptomyces tsukubensis. It is a macrolide lactone and acts by inhibiting calcineurin . The drug is used primarily in liver and kidney transplantations, although in some clinics it is used in heart, lung, and heart/lung transplantations.
At 5 years post-transplant, 80% of lung transplants, 60% of heart transplants and 50% of kidney transplants are affected, while liver transplants are only affected 10% of the time. [20] Therefore, chronic rejection explains long-term morbidity in most lung-transplant recipients, [ 23 ] [ 24 ] the median survival roughly 4.7 years, about half ...
Kidney transplantation is a life-extending procedure. [87] The typical patient will live 10 to 15 years longer with a kidney transplant than if kept on dialysis. [88] The increase in longevity is greater for younger patients, but even 75-year-old recipients (the oldest group for which there is data) gain an average four more years of life.
Solid organ transplant recipients After undergoing solid organ transplant (liver, kidney, pancreas, etc.), patients are prescribed immunosuppressive agents, such as tacrolimus or cyclosporine. These medications target CD4 immune cells, suppressing their function. IRIS in these patients is thought to be due to the pro-inflammatory response after ...