The transplanted child: New immunosuppressive agents and the need for pharmacokinetic monitoring

Pharmacokinetic monitoring has been insufficiently studied in paediatric solid organ transplantation, especially because some agents are relatively new to paediatric use, are of new formulation modification or are being used in combinations not previously well studied. The choice of immunosuppressive drugs after paediatric renal transplantation is increasing. Cyclosporine A (CyA), tacrolimus and mycophenolate mofetil (MMF) use has become routine. While pharmacokinetic monitoring of CyA and tacrolimus is routine, few paediatric data on tacrolimus pharmacokinetics exist, and, for MMF, pharmacokinetic monitoring is performed in only a few Canadian centres. The aim of the present article is to provide guidelines for the use of these three drugs by using a large number of full pharmacokinetic profiles in children.