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Tailoring tacrolimus therapy in kidney transplantation
Thomas Jouve1,2, Johan Noble1,2, Lionel Rostaing1,2
1a Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation , Centre Hospitalier Universitaire (CHU) Grenoble-Alpes , Grenoble , France.
Expert Review of Clinical Pharmacology
|May 22, 2018
Summary
Optimizing tacrolimus (Tac) therapy in kidney transplantation is crucial. Minimizing Tac with everolimus, not mycophenolic acid, prevents antibody formation and cytomegalovirus infections while managing risks like posttransplant diabetes mellitus.
Area of Science:
- Nephrology
- Transplantation Immunology
Background:
- End-stage renal disease prevalence is rising globally.
- Kidney transplantation is the optimal treatment, necessitating lifelong immunosuppression.
- Tacrolimus (Tac) is a cornerstone immunosuppressant but carries nephrotoxicity risks.
Purpose of the Study:
- To evaluate the tailored use of Tac-based immunosuppressive therapy in kidney transplant recipients.
- To analyze the impact of Tac minimization strategies on clinical outcomes.
Main Methods:
- Systematic literature search in PubMed for relevant studies.
- Analysis of clinical trial data, including the TRANSFORM study.
Main Results:
- Over-minimization of Tac with mycophenolic acid (MPA) increases de novo donor-specific antibodies (DSA).
- Tac minimization combined with everolimus does not increase DSA and may prevent cytomegalovirus (CMV) infection.
- Tac therapy, irrespective of formulation, increases posttransplant diabetes mellitus risk compared to cyclosporine A.
Conclusions:
- Tac-based immunosuppression remains the preferred therapy for kidney transplant recipients.
- Therapy can be individualized to balance efficacy and minimize adverse events.
- Strategic Tac minimization, particularly with everolimus, offers significant clinical benefits.
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