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Abstract

Tacrolimus, a calcineurin inhibitor, has been the cornerstone of immunosuppressive regimens in renal transplant over 2 decades. This has significantly improved the outcomes of renal transplant, including reduction of acute rejection episodes, improvement of renal function and graft survival, and reduction of some of the adverse effects associated with cy closporine. However, use of tacrolimus is associated with a number of undesirable effects, such as nephrotoxicity, posttransplant diabetes mellitus, neurotoxicity, and cosmetic and electrolyte disturbances. To alleviate these effects, several strategies have been adopted to minimize or eliminate tacrolimus from maintenance regimens of immuno suppression, with some success. This review focuses on advancements in the under standing of the basic science related to tacrolimus and the clinical evidences that have examined the efficacy and safety of tacrolimus in renal transplant over the past 2 decades and highlights the future directions.

Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations

“…While reasons underlying this resistance to the supplementation effects are unclear, this study raises the importance of a regular monitoring of serum magnesium in LTx recipients, especially given that hypomagnesemia has been postulated to aggravate renal impairment and mediate the neurotoxic effects associated with cyclosporine A therapy [ 62 ]. Post-LTx hypomagnesemia is not only connected to the use of cyclosporine A but also of tacrolimus, the other calcineurin inhibitor, which is associated with nephrotoxicity [ 63 ]. Calcineurin inhibitors are believed to inhibit the expression of the magnesium transporter, transient receptor potential melastatin 6 (TRPM6), involved in renal magnesium reabsorption [ 64 ].…”

Utilization of Mycophenolic Acid, Azathioprine, Tacrolimus, Cyclosporin, Sirolimus, and Everolimus: Multinational Study

“…Although effective, it is a drug with a narrow therapeutic index and serious adverse drug reactions. It showed nephrotoxic and neurotoxic effects (26). Consumption of this drug in the observed period recorded a constant increase in all observed countries.…”

Autoimmune Hepatitis: a Review of Established and Evolving Treatments

“…On the downside, Van Thiel et al [49] reported reduction of kidney function after one year on TAC. Although others did not confirm those data in a small cohort [85], kidney failure on TAC is a well-documented side effect after solid organ transplantation [90].…”