Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients

Tielemans, Merel M.; Boekel, Gerben A.J. van; Gelder, Teun van; Tjwa, Eric T.; Hilbrands, Luuk B.

doi:10.1016/j.trre.2018.11.001

Cited by 19 publications

(15 citation statements)

References 120 publications

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“…Moreover, diarrhea and other changes in gastrointestinal motility can lead to an increase in Tac exposure. 96 Also, the inflammatory state of the patient is important to consider. It has been demonstrated that inflammatory cytokines may downregulate cytochrome P450 expression (phenoconversion).…”

Section: Isd Monitoring In Icu-admitted Covid-19 Patientsmentioning

confidence: 99%

Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug–Drug Interactions

Elens

Langman

Hesselink

et al. 2020

Therapeutic Drug Monitoring

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Background: COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none with universal consensus or proven efficacy. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 because of their immunosuppressed conditions due to chronic use of immunosuppressive drugs (ISDs). It is therefore likely that solid organ transplant recipients will be treated with these experimental antivirals. Methods: This article is not intended to provide a systematic literature review on investigational treatments tested against COVID-19; rather, the authors aim to provide recommendations for therapeutic drug monitoring of ISDs in transplant recipients infected with SARS-CoV-2 based on a review of existing data in the literature. Results: Management of drug-drug interactions between investigational anti-SARS-CoV-2 drugs and immunosuppressants is a complex task for the clinician. Adequate immunosuppression is necessary to prevent graft rejection while, if critically ill, the patient may benefit from pharmacotherapeutic interventions directed at limiting SARS-CoV-2 viral replication. Maintaining ISD concentrations within the desired therapeutic range requires a highly individualized approach that is complicated by the pandemic context and lack of hindsight. Conclusions: With this article, the authors inform the clinician about the potential interactions of experimental COVID-19 treatments with ISDs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.

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Section: Isd Monitoring In Icu-admitted Covid-19 Patientsmentioning

confidence: 99%

Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug–Drug Interactions

Elens

Langman

Hesselink

et al. 2020

Therapeutic Drug Monitoring

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“…Moreover, tacrolimus coadministered with MMF may significantly alter enterohepatic circulation, thereby increasing contact with intestinal cells and ultimately causing colitis[ 6 , 81 ]. In contrast, cyclosporin coadministered with MMF reduces the excretion of MPA metabolites, and could therefore reduce the incidence of gastrointestinal injury[ 82 ]. Finally, a significant improvement in MMF-related gastrointestinal symptoms was observed after replacement of MMF with mizoribine[ 83 ].…”

Section: Clinical and Histological Featuresmentioning

confidence: 99%

Gastrointestinal complications after kidney transplantation

Gioco

Corona

Ekser

et al. 2020

WJG

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Gastrointestinal complications are common after renal transplantation, and they have a wide clinical spectrum, varying from diarrhoea to post-transplant inflammatory bowel disease (IBD). Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for IBD in kidney transplant re-cipients despite immunosuppression. Differentiating the various forms of post-transplant colitis is challenging, since most have similar clinical and histological features. Drug-related colitis are the most frequently encountered colitis after kidney transplantation, particularly those related to the chronic use of mycophenolate mofetil, while de novo IBDs are quite rare. This review will explore colitis after kidney transplantation, with a particular focus on different clinical and histological features, attempting to clearly identify the right treatment, thereby improving the final outcome of patients.

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“…Diarrhea is a common side effect of immunosuppressive therapy, affecting up to 50% of patients following kidney transplantation 1 . Use of mycophenolic acid (MPA) has been identified as the main culprit 2,3 . In a previous survey, it was demonstrated that clinicians underestimate the prevalence of post‐transplantation diarrhea 4 .…”

Section: Total Population Mpa Non‐users Mpa Users P‐valuementioning

confidence: 99%

Discrepancy between self‐perceived mycophenolic acid‐associated diarrhea and stool water content after kidney transplantation

Douwes

Swarte

Post

et al. 2021

Clinical Transplantation

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Diarrhea is a common side effect of immunosuppressive therapy, affecting up to 50% of patients following kidney transplantation. 1 Use of mycophenolic acid (MPA) has been identified as the main culprit. 2,3 In a previous survey, it was demonstrated that clinicians underestimate the prevalence of post-transplantation diarrhea. 4 However, the clinical consequences of this diarrhea are serious,

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Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients

Cited by 19 publications

References 120 publications

Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug–Drug Interactions

Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug–Drug Interactions

Gastrointestinal complications after kidney transplantation

Discrepancy between self‐perceived mycophenolic acid‐associated diarrhea and stool water content after kidney transplantation

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