(In our study, we found that the initiation tacrolimus dose per kilogram of body weight was lower for patients with a higher BMI, but despite this, the initial tacrolimus levels were higher (Group 1: 6 ng/ml vs. Group 3: 7.5 ng/ml; Further, we observed that patients with higher BMI required a significantly lower tacrolimus dose per kilogram of body weight when dosing was based on trough target levels at months 1 and 6 posttransplantation.
Here in America the normal tacrolimus blood level is 5 to 10 for kidney transplant.
A number of formulations are available – Prograf, Advagraf and Adoport.
The second and third tacrolimus levels within this study were obtained at 2.5 (IQR: 1.1–3.1) and 7.5 (IQR: 6.5–10.5) months from the time of transplantation. The metabolism of tacrolimus varies depending on the expression of cytochrome P450 3A5 (CYP3A5) variant alleles with the expressors of CYP3A5*1 being rapid metabolisers and of CYP3A5*3 being slow metabolisers (Barry & Levine, Our current standard practice for dosing of tacrolimus in the immediate posttransplant period is based on patient weight as per the FDA recommendation (0.1 mg/kg body weight/day in two divided doses). 2007 Jul-Aug;39(6):2008-9. doi: 10.1016/j.transproceed.2007.05.079.Pollock-Barziv SM, Finkelstein Y, Manlhiot C, Dipchand AI, Hebert D, Ng VL, Solomon M, McCrindle BW, Grant D.Pediatr Transplant. Draughting the article or revising it: Rajkumar Chinnadura and Philip A. Kalra. This site needs JavaScript to work properly.
eCollection 2015.Lapeyraque AL, Kassir N, Théorêt Y, Krajinovic M, Clermont MJ, Litalien C, Phan V.Pediatr Nephrol. kgContinuous variables are expressed as median (interquartile range [IQR]). The Kruskal–Wallis The study was performed in accordance with the declaration of Helsinki and approval for this study was obtained from the Research and Innovation department of the Northern Care Alliance NHS Group (Ref: S19HRANA34). Epub 2010 Oct 5.Lumlertgul D, Noppakun K, Rojanasthien N, Kanchanarattanakorn K, Jittikanont S, Manoyot A, Bunnachak D, Ophascharoensuk V.Ann Biol Clin (Paris). The median BMI was 27.1 kg/mAs this was a real‐world study there was variation in the timing of the first tacrolimus assay (median Day 3 posttransplant, IQR 2–6 days) which may have depended upon the clinical state of the patients (e.g., due to delayed graft function).
Moreover, clearance, is significantly affected by co-administration with food and with additional factors such as length of posttransplantation time. I have read and accept the Wiley Online Library Terms and Conditions of UseOverweight kidney transplant recipients are at risk of being overdosed following standard bodyweight‐based tacrolimus starting doseRenal association clinical practice guideline in post‐operative care in the kidney transplant recipientA systematic review of the effect of CYP3A5 genotype on the apparent oral clearance of tacrolimus in renal transplant recipientsRegulation of the nitric oxide system in human adipose tissueBody mass index, weight‐adjusted immunosuppression and the risk of acute rejection and infection after kidney transplantation: a cohort studyOmental and subcutaneous adipose tissues of obese subjects release interleukin‐6: depot difference and regulation by glucocorticoidTacrolimus dose requirement in renal transplant recipients is significantly higher when used in combination with corticosteroidsTacrolimus trough levels after month 3 as a predictor of acute rejection following kidney transplantation: a lesson learned from DeKAF GenomicsConsensus document: therapeutic monitoring of tacrolimus (FK–506)Adipose tissue tumor necrosis factor and interleukin‐6 expression in human obesity and insulin resistanceWhich kidney transplant recipients can benefit from the initial tacrolimus dose reduction?Genetic contribution to variable human CYP3A‐mediated metabolismWeight‐based tacrolimus trough concentrations post liver transplantMechanisms of lower maintenance dose of tacrolimus in obese patientsTherapeutic monitoring of calcineurin inhibitors for the nephrologist pharmacokinetics of calcineurin inhibitorsThe interactions of age, sex, body mass index, genetics, and steroid weight‐based doses on tacrolimus dosing requirement after adult kidney transplantationTacrolimus trough concentration variability and disparities in African American kidney transplantation Tacrolimus, a macrolide immunosuppressant agent, is indicated for the prophylaxis of organ rejection in patients receiving allogenic liver or kidney transplantation.
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Distribution of tacrolimus dose (mg) per kilogram of body weight across the body mass index groups at the three time periods (baseline, after 1 month and after 6 months posttransplant)Correlation between body weight and tacrolimus dose per kilogram of body weight doi: 10.1371/journal.pone.0127995.
The Kidney Disease Improving Global Outcomes has recommended 5–15 ng/mL of tacrolimus at the early posttransplant stage.7However, recent studies have challenged previous results.
Successful therapy is complicated by both intra- and inter-patient variability in drug absorption, coupled with the drug's narrow therapeutic index. Tacrolimus has proven its usefulness in solid organ transplants, but this study demonstrates that it is essential to carry out close monitoring through the application of pharmacokinetic concepts to optimize therapy.