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Tytuł:
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Tacrolimus and Mycophenolic Acid Blood Concentration and Cellular Rejection After Heart Transplantation in First Endomyocardial Biopsy.
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Autorzy:
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Nadziakiewicz P; Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland. Electronic address: .
Grochla M; Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Krauchuk A; Department of Anaesthesiology, Medical University of Silesia, Szpital Specjalistyczny, Zabrze, Poland.
Szyguła-Jurkiewicz B; 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.
Lorek J; Students' Scientific Society, Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Barańska A; Students' Scientific Society, Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Zembala MO; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland.
Przybyłowski P; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland; General Surgery, Medical College, Jagiellonian University, Cracow, Poland.
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Źródło:
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Transplantation proceedings [Transplant Proc] 2020 Sep; Vol. 52 (7), pp. 2094-2097. Date of Electronic Publication: 2020 Jun 20.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: New York, N.Y. : Elsevier Science Inc.
Original Publication: New York Stratton.
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MeSH Terms:
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Graft Rejection/*epidemiology
Heart Transplantation/*adverse effects
Immunosuppressive Agents/*blood
Mycophenolic Acid/*blood
Tacrolimus/*blood
Adult ; Female ; Graft Rejection/prevention & control ; Humans ; Immunosuppressive Agents/pharmacokinetics ; Incidence ; Male ; Middle Aged ; Mycophenolic Acid/pharmacokinetics ; Retrospective Studies ; Tacrolimus/pharmacokinetics
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Substance Nomenclature:
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0 (Immunosuppressive Agents)
HU9DX48N0T (Mycophenolic Acid)
WM0HAQ4WNM (Tacrolimus)
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Entry Date(s):
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Date Created: 20200624 Date Completed: 20201207 Latest Revision: 20201214
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Update Code:
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20240105
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DOI:
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10.1016/j.transproceed.2020.03.006
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PMID:
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32571700
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Background: Tacrolimus and mycophenolic acid (MPA) are the most important immunosuppressive drugs in modern heart transplantation. The pharmacokinetics of tacrolimus are best described by a 2-compartment model. MPA has very variable pharmacokinetics. The aim of this research was to compare kinetics of the immunosuppressants' blood levels in a group of patients with and without graft rejection.
Materials and Methods: The study was a retrospective analysis of 39 consecutive adult orthotopic heart transplantations (OHT): 10 (9 men and 1 woman) in group R had graft rejection (ISHLT >2) in the first biopsy and 29 (22 men and 7 women) in group C were without rejection. Ischemic cardiomyopathy occurred in 2 of 7 and nonischemic cardiomyopathy in 8 of 22 (group R and group C, respectively).
Results: Patients did not differ between groups except diabetes, which occurred more often in group R. Immunosuppressive drug levels were: group R and group C, respectively, 2.13 ± 0.49 and 2.11 ± 0.72 μg/mL; P = .93 for mycophenolate mofetil (MMF) and 9.42 ± 1.76 and 9.63 ± 2.30 ng/mL; P = .75 for tacrolimus. ICU stay was 14 ± 11 vs 15 ± 15 days; P = .76. There were 2 of 6 primary graft failures, 1 of 1 neurologic complications, and 0 of 6 reoperations (P < .05) in group R and group C, respectively. One patient died from group C in 30 days. During the hospital stay the incidence of graft rejection was diagnosed in 20 patients (16men and 4 women) (ISHLT >2 in endomyocardial biopsy) in the study population.
Conclusions: Monitoring of tacrolimus concentration in the early post--heart transplant period does not identify patients with rejection in the authors' study. Monitoring concentration of MMF does not identify patients with rejection. Further investigation is needed to evaluate factors responsible for post--heart transplant rejection in the early phase.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
