Two- to three-fold increase in blood tacrolimus (FK506) levels during diarrhea in liver-transplanted children

Clinical Transplantation
Juan Iglesias BerengueCarlos Margarit-Creixell

Abstract

The diagnosis and treatment of diarrhea in liver transplant recipients often pose a challenge owing to the variety of infectious and non-infectious causes. However, diagnosis is principally focused on ruling out an infectious etiology. Tacrolimus, an immunosuppressive agent generally used after liver transplantation, is absorbed mainly from the duodenum through the upper jejunum. It can be assumed that metabolism of the drug will be influenced by diarrhea. Four liver transplant recipients who developed an episode of acute gastroenteritis. Infectious etiology was confirmed; trough tacrolimus levels were measured before, during and after gastroenteritis. All patients presented a two- to three-fold increase in blood tacrolimus levels after the onset of gastroenteritis. Until the role played by the intestine in the metabolism of tacrolimus is fully understood, it is prudent to recommend early dose reduction of tacrolimus and careful monitoring of trough levels during diarrheal disorders of any nature in pediatric liver-transplanted patients.

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Citations

May 13, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Wim LemahieuYves Vanrenterghem
Mar 19, 2005·Transplant International : Official Journal of the European Society for Organ Transplantation·I StelzmuellerH Bonatti
Apr 22, 2004·Pharmacotherapy·William A PrescottJeong M Park
Sep 19, 2008·Clinical Transplantation·Suphamai Bunnapradist, Patrice M Ambühl

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