Effect of Jejunal Administration on Tacrolimus Trough Concentrations in a Pediatric Liver Transplant Recipient

Area of Science:

• Pediatric Gastroenterology
• Transplantation Medicine
• Clinical Pharmacy

Background:

• Calcineurin inhibitors like tacrolimus are essential for preventing rejection in pediatric liver transplant recipients.
• Tacrolimus administration poses challenges in pediatric patients, with limited guidance on non-oral, enteral routes.
• Enteral nutrition via jejunostomy tube (J-tube) is sometimes necessary for pediatric patients post-transplant.

Purpose of the Study:

• To report a case of tacrolimus administration via J-tube in a pediatric liver transplant recipient.
• To highlight the impact of J-tube administration on tacrolimus bioavailability and trough concentrations.
• To inform clinical practice regarding tacrolimus dosing in pediatric patients requiring J-tube feeding.

Main Methods:

• A case report of an 11-year-old male liver transplant recipient.
• Transition of tacrolimus from oral to J-tube administration.
• Monitoring of tacrolimus trough concentrations during oral and J-tube administration.
• Dose adjustments based on therapeutic drug monitoring.

Main Results:

• Tacrolimus trough concentrations significantly declined after switching to J-tube administration.
• Subtherapeutic tacrolimus levels persisted despite a threefold dose increase via J-tube.
• Upon returning to oral administration, tacrolimus levels became supratherapeutic, necessitating dose reduction.

Conclusions:

• Jejunostomy tube administration of tacrolimus in pediatric liver transplant patients can lead to reduced bioavailability.
• Increased tacrolimus dosing may be required when administered via J-tube.
• Careful therapeutic drug monitoring and dose adjustments are critical when transitioning tacrolimus between oral and J-tube routes.