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Sublingual Tacrolimus in Liver Transplantation: A Valid Option?

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Area of Science:

  • Transplantation Medicine
  • Pharmacology
  • Immunosuppression

Background:

  • Oral tacrolimus (Tac) is the standard immunosuppressant for solid organ transplant recipients.
  • Limited data exist on sublingual (SL) Tac in adult liver transplant (LT) patients.
  • SL Tac is proposed as an alternative administration route.

Purpose of the Study:

  • To evaluate the safety and efficacy of sublingual tacrolimus (SL Tac) in adult liver transplant recipients.
  • To assess SL Tac as an alternative for patients with oral intolerance or suboptimal drug levels.

Main Methods:

  • Three adult liver transplant recipients were studied.
  • Two patients switched from oral to SL Tac due to erratic serum concentrations.
  • One patient switched due to severe oral intolerance; SL Tac initiated at a 1:2 dose conversion.

Main Results:

  • All patients tolerated SL Tac without adverse events.
  • Patients 1 and 2 showed significant improvement in therapeutic trough concentrations after switching to SL Tac.
  • Patient 2 achieved stable therapeutic levels on SL Tac after consistently subtherapeutic levels with oral Tac.

Conclusions:

  • Sublingual tacrolimus (SL Tac) is a safe alternative for liver transplant recipients.
  • SL Tac can be considered when oral administration is not viable.
  • This route may improve drug concentration management in select patients.