Tailoring tacrolimus therapy in kidney transplantation

Expert Review of Clinical Pharmacology
Thomas JouvePaolo Malvezzi

Abstract

The prevalence of end-stage renal disease is increasing worldwide. The best treatment is kidney transplantation, although life-long immunosuppressive therapy is then mandatory. Currently, the cornerstone immunosuppressive therapy relies on tacrolimus, a calcineurin inhibitor that is nephrotoxic but whose exposition can be minimized in a delicate balance. Area covered: We addressed whether, in the setting of kidney transplantation, tacrolimus-based therapy can be tailored to medical needs: to achieve this, we searched for suitable articles in PubMed. Expert commentary: Too over-minimization of tacrolimus, when associated with mycophenolic acid (MPA), may cause the development of de novo donor-specific alloantibodies (DSA). However, tacrolimus minimization, in the context of everolimus-associated therapy instead of MPA, does not increase DSA formation as demonstrated in the TRANSFORM study and, in addition, can prevent cytomegalovirus infection/reactivation. Nonetheless, tacrolimus therapy, regardless of its formulation (immediate or extended release) compared to cyclosporine A, increases the risk of posttransplant diabetes mellitus; this increase is not affected by steroid therapy. tacrolimus-based immunosuppression is still the...Continue Reading

References

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Citations

Apr 7, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Moataz E MohamedUNKNOWN DeKAF Genomics and GEN03 Investigators
Jun 4, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Stefan P BergerUNKNOWN TRANSFORM investigators
Oct 15, 2019·European Journal of Clinical Investigation·Tong-Wei GuanKe-Bao Chen
Mar 27, 2019·International Journal of Environmental Research and Public Health·Cheol ParkYung Hyun Choi

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