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A comprehensive review of the impact of tacrolimus intrapatient variability on clinical outcomes in kidney transplantation
Author(s) -
Gonzales Haley M.,
McGillicuddy John W.,
Rohan Vinayak,
Chandler Jessica L.,
Nadig Satish N.,
Dubay Derek A.,
Taber David J.
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16002
Subject(s) - medicine , tacrolimus , therapeutic drug monitoring , intensive care medicine , transplantation , kidney transplantation , risk assessment , trough level , pharmacokinetics , computer security , computer science
Tacrolimus (Tac) is widely used to prevent rejection and graft loss in solid organ transplantation. A limiting characteristic of Tac is the high intra and interpatient variability associated with its use. Routine therapeutic drug monitoring (TDM) is necessary to facilitate Tac management and to avoid undesirable clinical outcomes. However, whole blood trough concentrations commonly utilized in TDM are not strong predictors of the detrimental clinical outcomes of interest. Recently, researchers have focused on Tac intrapatient variability (Tac IPV) as a novel marker to better assess patient risk. Higher Tac IPV has been associated with a number of mechanisms leading to shortened graft survival. Medication nonadherence (MNA) is considered to be the primary determinant of high Tac IPV and perhaps the most modifiable risk factor. An understanding of the methodology behind Tac IPV is imperative to its recognition as an important prognostic measure and integration into clinical practice. Therapeutic interventions targeting MNA and reducing Tac IPV are crucial to improving long‐term graft survival.