Transplantation is the most appropriate therapy for several conditions of end-stage organ failure, such as renal, hepatic or cardiac failure. Hepatic and cardiac transplantation are life-saving measures and are undertaken when conservative therapies have failed. The number of liver transplants performed in Europe has increased, reaching plateau of close to 4000 liver transplants performed annually. Renal transplantation rescues patients from the fate of chronic dialysis and improves patient quality of life to near normality. Transplantation has become a very successful procedure with success rates greater than 90% at 1-year post-transplant, regardless of the kind of transplanted organ. In current clinical practice the oral formulations of available calcineurin inhibitors, cyclosporine and tacrolimus, are generally administered on a twice daily basis. Poor compliance has been shown to be one of the factors associated with late graft loss demonstrated a statistically significant association for adherence to medication regimen with once daily dosing versus twice daily dosing in adult kidney transplant recipients. Advagraf is a new oral formulation of tacrolimus with prolonged-release characteristics compared to the currently authorised product Prograf(t). Because the later product is nationally authorised, the invented name may vary depending on the country of authorisation. Advagraf is the first calcineurin inhibitor formulated to enable once daily dosing and it is expected that it may help to improve compliance with dosing and cause less interference with the daily life activities of the patient. The active substance, tacrolimus, belongs to the pharmacological class of calcineurin inhibitors and originally derives from the fungus streptomyces tsukubaensis: it has a macrolide structure. Tacrolimus has been in use as an immunosuppressant in a variety of organ transplantation settings since 1989; there is extensive existing therapeutic experience with the substance. The proposed indication for Advagraf is in the (1) prophylaxis of transplant rejection (primary immunosuppression and maintenance therapy) in adult kidney or liver allograft recipients; (2) conversion from Prograf(t) capsules taken twice daily to Advagraf prolonged-release capsules taken once daily in adult allograft recipients; (3) treatment of allograft rejection resistant to treatment with other immunosuppressive drugs in adult patients. The proposed dosage is based on starting dose that depends on type of indication and transplanted organ and followed by therapeutic drug monitoring including measurement of through whole blood concentrations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.