Current Biochemical Monitoring and Risk Management of Immunosuppressive Therapy after Transplantation

Abstract

SummaryImmunosuppressive drugs play a crucial role in the inhibition of immune reaction and prevention of graft rejection aswell as in the pharmacotherapy of autoimmune disorders. Effective immunosuppression should provide an adequate safety profile and improve treatment outcomes and the patients' quality of life. High-risk transplant recipients may be identified, but a definitive prediction model has still not been recognized. Therapeutic drug monitoring (TDM) for immunosuppressive drugs is an essential, but at the same time insufficient tool due to low predictability of drug exposition and marked pharmacokinetic variability. Parallel therapeutic, biochemical and clinical monitoring may successfully optimize and individualize therapy for transplanted recipients, providing optimal medical outcomes. Modern pharmacotherapy management should include new biomarkers with better sensitivity and specificity that can identify early cell damage. The aim of this study was to point out the importance of finding new biomarkers that would enable early detection of adverse drug events and cell damage in organ transplant recipients. We wanted to confirm the importance of routine biochemical monitoring in improving the safety of immunosuppressive treatment.

Evaluation of the effect of Retrograde Intrarenal Surgery with Myo-Inositol Oxygenase

“…In our another study 12 we also found that MIOX is a significant parameter in the diagnosis of AKI. Similarly, in the present study, we measured the MIOX enzyme to evaluate the effect of RIRS on the kidneys.…”

Correlation of progesterone levels on the day of oocyte retrieval with basal hormonal status and the outcome of ART

“…Possible explanations for the discrepancies in the findings are the use of retrospective study design, the use of different protocols of controlled ovarian stimulation, and different cutoff levels for P4at the time of data analysis. Some studies imprecisely define references for elevated serum P4 levels, and there is variation in the statistical methods used to estimate specific circulating P4 limit values and in the precision of P4measurements that use different immunoassays 12 , 13 . The cutoff of P4 absolute concentrations on the day of hCG administration generally ranges from 0.8 to 2 ng/ml 14 – 16 .…”

Exploring sirolimus pharmacokinetic variability using data available from the routine clinical care of renal transplant patients – population pharmacokinetic approach

“…Numerous sources of pharmacokinetic variability have been recognized in the conventional pharmacokinetic studies of sirolimus (8, 9, 10, 11, 12, 13, 14, 15). Results of these studies suggest the influence of age, food, hepatic impairment and race on sirolimus pharmacokinetic parameters (4, 8, 12, 13, 14, 15). In contrast, only a few population studies have been conducted to assess the pharmacokinetics of sirolimus in kidney transplant patients (16, 17, 18, 19).…”

“…Effective immunosuppression plays a crucial role in the successful post-transplantation period. Sirolimus, immunosuppressive which inhibits the cellular response to IL-2 and T-cell proliferation, is approved for the prevention of organ rejection in kidney transplant patients (1, 2, 3, 4). Sirolimus is characterized by highly variable absorption and elimination which result in substantial blood concentrations differences among patients receiving the same doses (5).…”