Open AccessCombined approach with therapeutic drug monitoring and pharmacogenomics in renal transplant recipients
Author(s) -
S Manvizhi,
BS Mathew,
DH Fleming,
Gopal Basu,
George T. John
Publication year - 2013
Publication title -
indian journal of nephrology/indian journal of nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.317
H-Index - 24
eISSN - 1998-3662
pISSN - 0971-4065
DOI - 10.4103/0971-4065.107216
Subject(s) - tacrolimus , medicine , pharmacogenomics , therapeutic drug monitoring , renal transplant , trough level , transplantation , pharmacology , cyp3a5 , kidney transplantation , sirolimus , drug , gene , genotype , biology , genetics
In patients undergoing renal transplantation, dose individualization for tacrolimus is routinely achieved with therapeutic drug monitoring (TDM). The patient started on 5.5 mg/day of tacrolimus had a significantly elevated tacrolimus trough concentration. The tacrolimus dose was regularly reduced following TDM at many time periods in the post transplant period but the tacrolimus concentration was consistently elevated. Genomic analysis done after four years revealed mutations in the genes encoding for CYP3A5 and MDR1 (2677G > T). Pharmacogenomics alongside TDM, will soon emerge as the backbone of dose individualization. But for genomics to be beneficial, it should be advocated in the pre-transplant or early post transplant period.