Cited by 142Renal Transplantation Outcomes and TreatmentsPharmacogenetics and Drug MetabolismAntibiotics Pharmacokinetics and Efficacy

Pharmacokinetic considerations related to therapeutic drug monitoring of tacrolimus in kidney transplant patients

Open access
Andrews, Louise M., Li, Yi, De Winter, Brenda C. M., Shi, Yun-Ying, Baan, Carla C., Van Gelder, Teun, Hesselink, Dennis A.·2017·Expert Opinion on Drug Metabolism & Toxicology

Abstract

INTRODUCTION: Tacrolimus (Tac) is the cornerstone of immunosuppressive therapy after solid organ transplantation and will probably remain so. Excluding belatacept, no new immunosuppressive drugs were registered for the prevention of acute rejection during the last decade. For several immunosuppressive drugs, clinical development halted because they weren't sufficiently effective or more toxic. Areas covered: Current methods of monitoring Tac treatment, focusing on traditional therapeutic drug monitoring (TDM), controversies surrounding TDM, novel matrices, pharmacogenetic and pharmacodynamic monitoring are discussed. Expert opinion: Due to a narrow therapeutic index and large interpatient pharmacokinetic variability, TDM has been implemented for individualization of Tac dose to maintain drug efficacy and minimize the consequences of overexposure. The relationship between predose concentrations and the occurrence of rejection or toxicity is controversial. Acute cellular rejection also occurs when the Tac concentration is within the target range, suggesting that Tac whole blood concentrations don't necessarily correlate with pharmacological effect. Intracellular Tac, the unbound fraction of Tac or pharmacodynamic monitoring could be better biomarkers/tools for adequate Tac exposure - research into this has been promising. Traditional TDM, perhaps following pre-emptive genotyping for Tac-metabolizing enzymes, must suffice for a few years before these strategies can be implemented in clinical practice.

Integrity signals

Registry

Crossref · 10.1080/17425255.2017.1395413

Cites

134 of 134 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Andrews, L. M., Li, Y., De Winter, B. C. M., Shi, Y.-Y., Baan, C. C., Van Gelder, T., & Hesselink, D. A.
Affiliations
  • Erasmus MC (NL)
  • Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  • Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
Corresponding author
Hesselink, Dennis A.
Venue
Expert Opinion on Drug Metabolism & Toxicology
Published
2017-10-30
Volume
13
Issue
12
Pages
1225-1236
ISSN
  • 1742-5255 (ISSN-L)
  • 1744-7607
OpenAlex
W2765312142
Cited by
142
References
134
Citations by year
2026: 9 · 2025: 8 · 2024: 16 · 2023: 19 · 2022: 9 · 2021: 17 · 2020: 30 · 2019: 16 · 2018: 9
FWCI
4.00
Type
journal article
Language
en
Open access
Locations
  • Expert Opinion on Drug Metabolism & Toxicology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
  • Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
Keywords
tacrolimus, therapeutic drug monitoring, kidney transplantation, immunosuppressive therapy, pharmacokinetics, pharmacogenetics, pharmacodynamic monitoring, acute cellular rejection, individualized dosing, drug toxicity
MeSH terms
Dose-Response Relationship, Drug, Genotype, Graft Rejection, Humans, Immunosuppressive Agents, Pharmacogenetics, Kidney Transplantation, Tacrolimus, Drug Monitoring

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review