Low Tacrolimus Dose Requirements in Renal Transplant Recipients in the Omani Population: Implications for Pharmacogenetics?

Mohsin, Nabil; Pakkyara, Abbas; Budruddin, M.; Obaid, Florencia; Kumar, Aparna; Malvathu, S.; Kalankara, S.; Amitabh, A.; As, Daar

doi:10.1016/j.transproceed.2005.07.027

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…However, there are risks inherent with switching immunosuppressive regimens, including increased risk for AR, graft loss, and the introduction of new side effects (27). The most common reason for discontinuing CNI-based therapy is typically nephrotoxicity (18,19,28), although discontinuation because of non-nephrotoxic side effects is not uncommon (28). A study of 157 liver and kidney transplant recipients who could not continue tacrolimus-based therapy found that the most common reasons necessitating a therapy switch were neurotoxicity, diabetes, gastrointestinal intolerance, and nephrotoxicity (17).…”

Section: Discussionmentioning

confidence: 99%

“…Kidney transplant patients are switched from CNIs for various reasons, including AR, adverse events (e.g. hirsutism, gingival hypertrophy, and neurotoxicity), and chronic factors such as nephrotoxicity, diabetes, and dyslipidemia (17)(18)(19). However, there are challenges to switching immunosuppressive regimens, including increased risk of AR or graft loss and the introduction of new adverse events.…”

Section: Introductionmentioning

confidence: 99%

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Switching from Calcineurin Inhibitor-based Regimens to a Belatacept-based Regimen in Renal Transplant Recipients

Rostaing

Massari

Garcı́a

et al. 2011

Clinical Journal of the American Society of Nephrology

161

172

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SummaryBackground and objectives Prolonged use of calcineurin inhibitors (CNIs) in kidney transplant recipients is associated with renal and nonrenal toxicity and an increase in cardiovascular risk factors. Belatacept-based regimens may provide a treatment option for patients who switch from CNI-based maintenance immunosuppression.Design, setting, participants, & measurements This is a randomized, open-label Phase II trial in renal transplant patients with stable graft function and receiving a CNI-based regimen. Patients who were Ն6 months but Յ36 months after transplantation were randomized to either switch to belatacept or continue CNI treatment. All patients received background maintenance immunosuppression. The primary end point was the change in calculated GFR (cGFR) from baseline to month 12.Results Patients were randomized either to switch to belatacept (n ϭ 84) or to remain on a CNI-based regimen (n ϭ 89). At month 12, the mean (SD) change from baseline in cGFR was higher in the belatacept group versus the CNI group. Six patients in the belatacept group had acute rejection episodes, all within the first 6 months; all resolved with no allograft loss. By month 12, one patient in the CNI group died with a functioning graft, whereas no patients in the belatacept group had graft loss. The overall safety profile was similar between groups. ConclusionsThe study identifies a potentially safe and feasible method for switching stable renal transplant patients from a cyclosporine-or tacrolimus-based regimen to a belatacept-based regimen, which may allow improved renal function in patients currently treated with CNIs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Switching from Calcineurin Inhibitor-based Regimens to a Belatacept-based Regimen in Renal Transplant Recipients

Rostaing

Massari

Garcı́a

et al. 2011

Clinical Journal of the American Society of Nephrology

161

172

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“…In Kuwait, the number of patients with kidney transplantation (KT) is increasing with 20 living donors in the early 1990s to 77 patients (47 living and 30 deceased donors) in 2015. Few studies were published in the Middle East and North Africa (MENA) region to compare TAC-based vs. cyclosporine-based regimens and associated outcomes (El-Agroudy et al, 2008;Alghamdi et al, 2011), examined TAC dose requirements among their population (Mohsin et al, 2005), and assess factors associated with the development of PTDM following KT (Al-Ghareeb et al, 2012;Abdulrahman et al, 2018). However, there are no studies in the literature that evaluated TAC dosage regimen, monitoring, and associated outcomes after KT in Kuwait.…”

Section: Introductionmentioning

confidence: 99%

Monitoring Tacrolimus Trough Concentrations During the First Year After Kidney Transplantation: A National Retrospective Cohort Study

et al. 2020

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Background: There is a lack of data in the literature on the evaluation of tacrolimus (TAC) dosage regimen and monitoring after kidney transplantation (KT) in Kuwait. The aim of the present study was to evaluate TAC dosing in relation to the hospital protocol, the achievement of target TAC trough concentration (C0), the prevalence of TAC side effects (SEs), namely, posttransplant diabetes mellitus (PTDM), denovo hypertension (HTN), and dyslipidemia, and factors associated with the occurrence of these SEs among KT recipients.Methods: A retrospective study was conducted among 298 KT recipients receiving TAC during the first year of PT. Descriptive and multivariate logistic regression analyses were used.Results: The initial TAC dosing as per the local hospital protocol was prescribed for 28.2% of patients. The proportion of patients who had C0 levels within the target range increased from 31.5 to 60.3% during week 1 through week 52. Among patients who did not have HTN, DM, or dyslipidemia before using TAC, 78.6, 35.2, and 51.9% of them were prescribed antihypertensive, antidiabetic, and antilipidemic medications during the follow-up period. Age of ≥40 years was significantly associated with the development of de novo HTN, dyslipidemia, and PTDM (p < 0.05). High TAC trough concentration/daily dose (C0/D) ratio was significantly associated with the development of PTDM (p < 0.05).Conclusion: Less than two-fifths of patients achieved target TAC C0 levels during the first month of PT. Side effects were more common in older patients. These findings warrant efforts to implement targeted multifaceted interventions to improve TAC prescribing and monitoring after KT.

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Forty Years of Publication of Transplantation Proceedings—The Fourth Decade: Globalization of the Enterprise

Kahan

2011

Transplantation Proceedings

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Low Tacrolimus Dose Requirements in Renal Transplant Recipients in the Omani Population: Implications for Pharmacogenetics?

Cited by 3 publications

References 3 publications

Switching from Calcineurin Inhibitor-based Regimens to a Belatacept-based Regimen in Renal Transplant Recipients

Switching from Calcineurin Inhibitor-based Regimens to a Belatacept-based Regimen in Renal Transplant Recipients

Monitoring Tacrolimus Trough Concentrations During the First Year After Kidney Transplantation: A National Retrospective Cohort Study

Forty Years of Publication of Transplantation Proceedings—The Fourth Decade: Globalization of the Enterprise

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